van Tulder M W, Ostelo R, Vlaeyen J W, Linton S J, Morley S J, Assendelft W J
Institute for Research in Extramural Medicine, Free University, Amsterdam, The Netherlands.
Spine (Phila Pa 1976). 2000 Oct 15;25(20):2688-99. doi: 10.1097/00007632-200010150-00024.
A systematic review of randomized controlled trials.
The treatment of chronic low back pain is not primarily focused on removing an underlying organic disease but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioral interventions are commonly used in the treatment of chronic (disabling) low back pain.
To determine whether behavioral therapy is more effective than reference treatments for chronic nonspecific low back pain and which type of behavioral treatment is most effective.
The authors searched the Medline and PsychLit databases and the Cochrane Controlled Trials Register up to April 1999, and Embase up to September 1999. Also screened were references of identified randomized trials and relevant systematic reviews. Methodologic quality assessment and data extraction were performed independently by two reviewers. The magnitude of effect was assessed by computing a pooled effect size for each domain (i.e., behavioral outcomes, overall improvement, back pain-specific and generic functional status, return to work, and pain intensity) using the random effects model.
Only six (25%) studies were high quality. There is strong evidence (level 1) that behavioral treatment has a moderate positive effect on pain intensity (pooled effect size 0.62; 95% confidence interval [CI] 0. 25, 0.98), and small positive effects on generic functional status (pooled effect size 0.35; 95% CI: 0.04, 0.74) and behavioral outcomes (pooled effect size 0.40; 95% CI: 0.10, 0.70) of patients with chronic low back pain when compared with waiting-list controls or no treatment. There is moderate evidence (level 2) that a addition of behavioral component to a usual treatment program for chronic low backpain has no positive short-term effect on generic functional status (pooled effect size 0.31; 95% CI: 0.01, 0.64), pain intensity (pooled effect size 0.03; 95% CI: 0.30,0.36), and behavioral outcomes (pooled effect size 0.19; 95% CI: 0.08, 0.45).
Behavioral treatment seems to be an effective treatment for patients with chronic low back pain,but it is still unknown what type of patients benefit most from what type of behavioral treatment.
对随机对照试验的系统评价。
慢性下腰痛的治疗并非主要着眼于消除潜在的器质性疾病，而是通过改变环境因素和认知过程来减少残疾。行为干预常用于慢性（致残性）下腰痛的治疗。
确定行为疗法对慢性非特异性下腰痛是否比对照治疗更有效，以及哪种类型的行为治疗最有效。
作者检索了截至1999年4月的Medline和PsychLit数据库以及Cochrane对照试验注册库，以及截至1999年9月的Embase数据库。还筛选了已识别的随机试验的参考文献和相关的系统评价。两名评审员独立进行方法学质量评估和数据提取。使用随机效应模型计算每个领域（即行为结果、总体改善、下腰痛特异性和一般功能状态、重返工作岗位和疼痛强度）的合并效应量来评估效应大小。
只有六项（25%）研究质量较高。有强有力的证据（1级）表明，与等待名单对照组或不治疗相比，行为治疗对慢性下腰痛患者的疼痛强度有中度积极影响（合并效应量0.62；95%置信区间[CI]0.25，0.98），对一般功能状态有小的积极影响（合并效应量0.35；95%CI：0.04，0.74）和行为结果（合并效应量0.40；95%CI：0.10，0.70）。有中等证据（2级）表明，在慢性下腰痛的常规治疗方案中添加行为成分对一般功能状态（合并效应量0.31；95%CI：0.01，0.64）、疼痛强度（合并效应量0.03；95%CI：0.30，0.36）和行为结果（合并效应量0.19；95%CI：0.08，0.45）没有短期积极影响。
行为治疗似乎是慢性下腰痛患者的一种有效治疗方法，但仍不清楚哪种类型的患者从哪种类型的行为治疗中获益最大。
