基于认知行为疗法原则对持续性腰痛患者进行的患者教育：一例报告。
Patient education based on principles of cognitive behavioral therapy for a patient with persistent low back pain: a case report.
机构信息
Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-262, Box 357236, Seattle, WA 98195-7236, USA.
出版信息
J Orthop Sports Phys Ther. 2010 Aug;40(8):494-501. doi: 10.2519/jospt.2010.3264.
STUDY DESIGN
Case report.
BACKGROUND
Cognitive behavioral therapy (CBT) is an effective intervention for patients with persistent pain. Recent research indicates that physical therapists self-perceive a lack of knowledge, skills, and time to provide this intervention. The purpose of this case report is to describe how specific CBT strategies can be integrated with multimodal physical therapist management of a patient with persistent low back pain.
CASE DESCRIPTION
The patient was a 70-year-old female with activity limitations of walking, standing, and forward bending. Oswestry Disability Questionnaire score was 19/50 and Fear-Avoidance Belief Questionnaire physical activity subscale was 23/24. The Low Back Activity Confidence Scale revealed 19%, 100%, and 84% for function, symptom self-regulation, and exercise, respectively. CBT-based patient education was provided in combination with manual therapy and exercise. CBT techniques included cognitive restructuring, goal setting, activity pacing, problem-solving strategies, graded exposure, encouraging exposure to pleasant experiences, and maintenance strategies.
OUTCOMES
The patient was discharged after 7 visits distributed over 21 weeks. Her Oswestry Disability Questionnaire score was reduced 10% and Fear-Avoidance Belief Questionnaire physical activity subscale score reduced 48%. On the Low Back Activity Confidence Scale the patient's scores were 19%, 87%, and 94% for function, symptom self-regulation, and exercise, respectively.
DISCUSSION
This case report describes the use of CBT techniques during patient education by a physical therapist. The patient demonstrated clinically measurable and significant improvements in disability. Improvements in both self-efficacy beliefs related to exercise and activity avoidance beliefs were associated with improvement in disability. Additional research is needed to determine best practices for CBT-based patient education by physical therapists.
LEVEL OF EVIDENCE
Therapy, level 4.
研究设计
病例报告。
背景
认知行为疗法（CBT）是治疗持续性疼痛患者的有效干预措施。最近的研究表明，物理治疗师自身认为缺乏提供这种干预的知识、技能和时间。本病例报告的目的是描述如何将特定的 CBT 策略与多模式物理治疗师管理持续性腰痛患者相结合。
病例描述
患者为 70 岁女性，存在步行、站立和前屈活动受限。Oswestry 残疾问卷评分为 19/50，Fear-Avoidance Belief Questionnaire 体力活动分量表评分为 23/24。低腰背活动信心量表显示功能、症状自我调节和运动分别为 19%、100%和 84%。在进行手法治疗和运动的同时，为患者提供了基于 CBT 的患者教育。CBT 技术包括认知重构、目标设定、活动节奏控制、解决问题策略、分级暴露、鼓励暴露于愉快体验，以及维持策略。
结果
患者在 7 次就诊后于 21 周后出院。她的 Oswestry 残疾问卷评分降低了 10%，Fear-Avoidance Belief Questionnaire 体力活动分量表评分降低了 48%。在低腰背活动信心量表上，患者的功能、症状自我调节和运动的评分分别为 19%、87%和 94%。
讨论
本病例报告描述了物理治疗师在患者教育过程中使用 CBT 技术。患者在残疾方面表现出具有临床意义的显著改善。运动自我效能信念和活动回避信念的改善与残疾的改善相关。需要进一步研究来确定物理治疗师基于 CBT 的患者教育的最佳实践。
证据水平
治疗，4 级。
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