O'Sullivan Kieran, Dankaerts Wim, O'Sullivan Leonard, O'Sullivan Peter B
K. O'Sullivan, PhD, MManipTher, BPhysio, Department of Clinical Therapies, University of Limerick, Limerick, Ireland.
W. Dankaerts, PhD, PGDipManipTher, BScPhysio, Department of Rehabilitation Sciences, University of Leuven, Leuven, Belgium.
Phys Ther. 2015 Nov;95(11):1478-88. doi: 10.2522/ptj.20140406. Epub 2015 Apr 30.
Multiple dimensions across the biopsychosocial spectrum are relevant in the management of nonspecific chronic low back pain (NSCLBP). Cognitive functional therapy is a behaviorally targeted intervention that combines normalization of movement and abolition of pain behaviors with cognitive reconceptualization of the NSCLBP problem while targeting psychosocial and lifestyle barriers to recovery.
The purpose of this study was to examine the effectiveness of cognitive functional therapy for people with disabling NSCLBP who were awaiting an appointment with a specialist medical consultant.
A multiple case-cohort study (n=26) consisting of 3 phases (A1-B-A2) was conducted.
Measurement phase A1 was a baseline phase during which measurements of pain and functional disability were collected on 3 occasions over 3 months for all participants. During phase B, participants entered a cognitive functional therapy intervention program involving approximately 8 treatments over an average of 12 weeks. Finally, phase A2 was a 12-month, no-treatment follow-up period. Outcomes were analyzed using repeated-measures analysis of variance or Friedman test (with post hoc Bonferroni correction) across 7 time intervals, depending on normality of data distribution.
Statistically significant reductions in both functional disability and pain were observed immediately postintervention and were maintained over the 12-month follow-up period. These reductions reached clinical significance for both disability and pain. Secondary psychosocial outcomes, including depression, anxiety, back beliefs, fear of physical activity, catastrophizing, and self-efficacy, were significantly improved after the intervention.
The study was not a randomized controlled trial. Although primary outcome data were self-reported, the assessor was not blinded.
These promising results suggest that cognitive functional therapy should be compared with other conservative interventions for the management of disabling NSCLBP in secondary care settings in large randomized clinical trials.
生物心理社会谱的多个维度与非特异性慢性下腰痛（NSCLBP）的管理相关。认知功能疗法是一种行为靶向干预，它将运动正常化和疼痛行为消除与NSCLBP问题的认知重新概念化相结合，同时针对心理社会和生活方式方面的康复障碍。
本研究的目的是检验认知功能疗法对等待专科医学顾问预约的致残性NSCLBP患者的有效性。
进行了一项多病例队列研究（n = 26），包括3个阶段（A1 - B - A2）。
测量阶段A1是基线阶段，在此期间，在3个月内对所有参与者进行3次疼痛和功能障碍测量。在阶段B，参与者进入认知功能疗法干预计划，平均在12周内进行约8次治疗。最后，阶段A2是12个月的无治疗随访期。根据数据分布的正态性，使用重复测量方差分析或Friedman检验（采用事后Bonferroni校正）在7个时间间隔内分析结果。
干预后立即观察到功能障碍和疼痛在统计学上有显著降低，并在12个月的随访期内得以维持。这些降低对残疾和疼痛均具有临床意义。干预后，包括抑郁、焦虑、背部信念、对体育活动的恐惧、灾难化思维和自我效能感在内的次要心理社会结果有显著改善。
该研究不是随机对照试验。尽管主要结局数据是自我报告的，但评估者未设盲。
这些有前景的结果表明，在大型随机临床试验的二级护理环境中，应将认知功能疗法与其他保守干预措施进行比较，以管理致残性NSCLBP。
