*Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone (Milan), Institute of Care and Research, Salvatore Maugeri Foundation, IRCCS †Neuroengineering and Medical Robotics Laboratory, Bioengineering Department, Politecnico di Milano ‡Consorzio Valutazioni Biologiche e Farmacologiche, Pavia University and Scientific Institute of Pavia, Institute of Care and Research, Salvatore Maugeri Foundation, IRCCS, Milan §Physical and Rehabilitation Medicine, Tor Vergata University of Rome, Rome, Italy.
Clin J Pain. 2013 Nov;29(11):929-38. doi: 10.1097/AJP.0b013e31827fef7e.
To evaluate the effect on disability, kinesiophobia, pain, and the quality of life of a long-lasting multidisciplinary program based on cognitive-behavioral therapy and targeted against fear-avoidance beliefs in patients with chronic low back pain.
parallel-group, randomized, superiority controlled study. Ninety patients were randomly assigned to a multidisciplinary program consisting of cognitive-behavior therapy and exercise training (experimental group, 45 patients) or exercise training alone (control group, 45 patients). Before treatment (T1), 5 weeks later (instructive phase, T2), and 12 (posttreatment analysis, T3) and 24 months after the end of the instructive phase (1-year follow-up, T4), all of the patients completed a booklet containing the Roland-Morris Disability Questionnaire Scale (primary outcome), the Tampa Scale for Kinesiophobia, a pain numerical rating scale, and the Short-Form Health Survey. A linear mixed model for repeated measures was used to analyze each outcome measure, and the reliable change index/clinically significant change method was used to assess the clinical significance of the changes.
The linear mixed model analysis showed a remarkable group, time, and interaction effect for group * time in all of the primary and secondary outcomes (P always <0.001). The majority of the patients in the experimental group achieved a reliable and clinically significant improvement, whereas the majority of those in the control group experienced no change.
The long-lasting multidisciplinary program was superior to the exercise program in reducing disability, fear-avoidance beliefs and pain, and enhancing the quality of life of patients with chronic low back pain. The effects were clinically tangible and lasted for at least 1 year after the intervention ended.
评估基于认知行为疗法并针对慢性下腰痛患者的恐惧回避信念的长效多学科方案对残疾、运动恐惧症、疼痛和生活质量的影响。
平行组、随机、优效对照研究。90 名患者被随机分配到多学科方案（认知行为疗法和运动训练）（实验组，45 名患者）或仅运动训练（对照组，45 名患者）。在治疗前（T1）、5 周后（指导阶段，T2）、12 周后（治疗后分析，T3）和指导阶段结束后 24 个月（1 年随访，T4），所有患者完成一本小册子，其中包含 Roland-Morris 残疾问卷量表（主要结局）、坦帕运动恐惧量表、疼痛数字评分量表和简明健康调查。使用重复测量线性混合模型分析每个结局指标，并使用可靠变化指数/临床显著变化方法评估变化的临床意义。
线性混合模型分析显示，所有主要和次要结局的组、时间和组*时间交互作用均具有显著意义（P 总是 <0.001）。实验组的大多数患者实现了可靠和临床显著的改善，而对照组的大多数患者则没有变化。
长效多学科方案在减轻残疾、恐惧回避信念和疼痛以及提高慢性下腰痛患者的生活质量方面优于运动方案。效果具有临床意义，并在干预结束后至少持续 1 年。
