Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, Alberta, Canada T6G 2G4.
Spine J. 2017 Nov;17(11):1722-1728. doi: 10.1016/j.spinee.2017.07.006. Epub 2017 Jul 26.
Psychological treatments delivered by non-psychologists have been proposed as a way to increase access to care to address important psychological barriers to recovery in people with low back pain (LBP).
This review aimed to synthesize randomized controlled trials (RCTs) that assess the effectiveness of psychological interventions delivered by non-psychologists in reducing pain intensity and disability in adults with LBP, compared with usual care.
A systematic review without meta-analysis was carried out.
Randomized controlled trials including adult patients with all types of musculoskeletal LBP were eligible. Interventions included those based on psychological principles and delivered by non-psychologists. The primary outcomes of interest were self-reported pain intensity and disability. Information sources included Medline, EMBASE, and the Cochrane Central Registrar for Controlled Trials. The Cochrane Collaboration's tool for assessing risk of bias was used for the evaluation of internal validity.
There were 1,101 records identified, 159 were assessed for eligibility, 16 were critically appraised, and 11 studies were included. Mild to moderate risk of bias was present in the included studies, with personnel and patient blinding, treatment fidelity, and attrition being the most common sources of bias. Considerable heterogeneity existed for patient population, intervention components, and comparison groups. Although most studies demonstrated statistical and clinical improvements in pain and disability, few were statistically superior to the comparison group.
Consistent with the broader psychological literature, psychological interventions delivered by non-psychologists have modest effects on low back pain and disability. Additional high quality research is needed to understand what patients are likely to respond to psychological interventions, the appropriate dose to achieve the desired outcome, the amount of training required to implement psychological interventions, and the optimal procedures to ensure treatment fidelity.
非心理学家提供的心理治疗被提议作为一种增加获得治疗的机会的方法，以解决与低背痛（LBP）患者康复相关的重要心理障碍。
本综述旨在综合评估非心理学家提供的心理干预措施在降低成人 LBP 患者疼痛强度和残疾方面的有效性，与常规护理相比。
这是一项没有进行荟萃分析的系统综述。
符合条件的随机对照试验包括患有各种肌肉骨骼 LBP 的成年患者。干预措施包括基于心理原则并由非心理学家提供的干预措施。主要关注的结局是自我报告的疼痛强度和残疾。信息来源包括 Medline、EMBASE 和 Cochrane 对照试验中央登记册。采用 Cochrane 协作组评估偏倚风险的工具对内部有效性进行评估。
共确定了 1101 条记录，评估了 159 条记录的资格，对 16 条记录进行了批判性评价，纳入了 11 项研究。纳入研究存在轻度至中度偏倚风险，人员和患者盲法、治疗一致性和脱落是最常见的偏倚来源。患者人群、干预措施组成部分和对照组存在相当大的异质性。尽管大多数研究表明疼痛和残疾方面有统计学和临床改善，但很少有研究在统计学上优于对照组。
与更广泛的心理文献一致，非心理学家提供的心理干预对低背痛和残疾有适度的影响。需要更多高质量的研究来了解患者可能对心理干预有何反应，达到预期结果所需的适当剂量，实施心理干预所需的培训量，以及确保治疗一致性的最佳程序。
