与单纯接受多模式手法治疗相比，对于同时接受多模式手法治疗的慢性下腰痛患者，在线心理干预是否能提高自我效能并改善残疾状况？一项随机对照试验的设计。

Does an online psychological intervention improve self-efficacy and disability in people also receiving Multimodal Manual Therapy for chronic low back pain compared to Multimodal Manual Therapy alone? Design of a randomized controlled trial.

作者信息

Petrozzi M John, Leaver Andrew, Jones Mairwen K, Ferreira Paulo H, Rubinstein Sidney M, Mackey Martin G

机构信息

Research Student, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.

Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.

出版信息

Chiropr Man Therap. 2015 Dec 18;23:35. doi: 10.1186/s12998-015-0080-9. eCollection 2015.

DOI:10.1186/s12998-015-0080-9

PMID:26692259

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4683746/

Abstract

BACKGROUND

Various interventions are available for the treatment of chronic low back pain (LBP), including Manual Therapy and Cognitive Behavioural Therapy (CBT). The purpose of this study is to evaluate whether the addition of an internet-based CBT program leads to better outcomes in patients who are treated with multimodal manual therapy for chronic LBP.

METHODS/DESIGN: A randomized controlled trial comparing a combined intervention, consisting of internet-based CBT utilising MoodGYM plus multimodal manual therapy, to multimodal manual therapy alone for patients with chronic LBP. Multimodal manual therapy will be delivered by experienced chiropractors and physiotherapists. Treatment sessions will consist of a combination of joint and soft tissue mobilisation; spinal manipulation as well as muscle and fascia massage; education and reassurance; and rehabilitative exercise prescription. In total, 108 adult participants will be recruited from multiple chiropractic and physiotherapy private practices in Australia. Participants older than 18 years of age and diagnosed with chronic non-specific LBP will be included in the trial, where chronic LBP is defined as continuous or fluctuating pain for a minimum of three months. The Keele STarT Back screening tool will be used to screen for potential participants who are in the medium risk category. The primary outcomes are self efficacy and disability measured by the Patient Self-Efficacy Questionnaire (PSEQ) and Roland Morris Disability Questionnaire (RMDQ) respectively. Secondary outcome measures will assess pain, catastrophising, depression, anxiety, stress and work ability. Participants will be randomly allocated into one of two groups. Both groups will receive an upper limit of 12 multimodal manual therapy sessions over a period of 8 weeks. The intervention group will also receive five weeks of MoodGYM covering five modules in total. Assessment will be conducted at pre-treatment, post-treatment 8- and follow-up at 26- and 52 weeks. In addition, a verbal pain measure will be completed by the treating practitioner at time of treatments on an 11-point VAS. The primary data analysis will be by intention to treat using a linear mixed model for each outcome.

DISCUSSION

This paper outlines the design of a randomised controlled trial that investigates the potential benefits of adding a widely available and inexpensive internet-based psychological intervention to standard multimodal manual therapy for the management of chronic low back pain.

TRIAL REGISTRATION

ACTRN12615000269538.

摘要

背景

治疗慢性下腰痛（LBP）有多种干预措施，包括手法治疗和认知行为疗法（CBT）。本研究的目的是评估在接受多模式手法治疗慢性LBP的患者中，增加基于互联网的CBT计划是否能带来更好的治疗效果。

方法/设计：一项随机对照试验，比较一种联合干预措施（包括使用MoodGYM的基于互联网的CBT加上多模式手法治疗）与单纯多模式手法治疗对慢性LBP患者的效果。多模式手法治疗将由经验丰富的脊椎按摩师和物理治疗师实施。治疗课程将包括关节和软组织松动术、脊柱推拿以及肌肉和筋膜按摩、教育和安慰以及康复运动处方。总共将从澳大利亚的多家脊椎按摩和物理治疗私人诊所招募108名成年参与者。年龄超过18岁且被诊断为慢性非特异性LBP的参与者将被纳入试验，其中慢性LBP定义为持续或波动疼痛至少三个月。将使用基尔STarT Back筛查工具对处于中度风险类别的潜在参与者进行筛查。主要结局分别是通过患者自我效能问卷（PSEQ）和罗兰·莫里斯残疾问卷（RMDQ）测量的自我效能和残疾程度。次要结局指标将评估疼痛、灾难化、抑郁、焦虑、压力和工作能力。参与者将被随机分配到两组中的一组。两组在8周内接受的多模式手法治疗疗程上限均为12次。干预组还将接受为期五周、共涵盖五个模块的MoodGYM治疗。将在治疗前、治疗后8周、26周和52周进行评估。此外，治疗医生将在每次治疗时使用11点视觉模拟量表（VAS）完成口头疼痛测量。主要数据分析将采用意向性分析，对每个结局使用线性混合模型。