Petrozzi M John, Leaver Andrew, Ferreira Paulo H, Rubinstein Sidney M, Jones Mairwen K, Mackey Martin G
1Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia.
2Department of Health Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
Chiropr Man Therap. 2019 Oct 25;27:54. doi: 10.1186/s12998-019-0277-4. eCollection 2019.
Low back pain (LBP) is prevalent, costly and disabling. A biopsychosocial treatment approach involving physical and cognitive behavioural therapy (CBT) is recommended for those with chronic LBP. It is not known if online psychological coaching tools might have a role in the secondary prevention of LBP related disability. To assess the effectiveness of an internet-delivered psychological program (MoodGYM) in addition to standard physical treatment in patients with chronic non-specific LBP at medium risk of ongoing disability.
A multisite randomized controlled trial was conducted with 108 participants (aged mean 50.4 ± 13.6 years) with chronic LBP attending one of six private physiotherapy or chiropractic clinics. Disability (Roland Morris Disability Questionnaire) and self-efficacy (Patient Self-Efficacy Questionnaire), were assessed at baseline, post-treatment (8-weeks) with follow-up at six- and twelve-months. Participants were randomized into either the intervention group, MoodGYM plus physical treatments, or the control group which received physical treatments alone.
No statistically significant between group differences were observed for either disability at post-treatment (Effect size (standardised mean difference) 95% CI) RMD - 0.06 (- 0.45,0.31), 6-months RMD 0.01 (- 0.38,0.39) and 12-months - 0.20 (- 0.62,0.17) or self-efficacy at post-treatment PSEQ 0.06 (- 0.31,0.45), 6-months 0.02 (- 0.36,0.41) and 12-months 0.21 (- 0.16,0.63).
There was no additional benefit of an internet-delivered CBT program (MoodGYM) to physical treatments in those with chronic non-specific LBP at medium risk of ongoing disability measured at post-treatment, or at 6 and 12 months.
This trial was prospectively registered with Australian New Zealand Clinical Trials Registry Number (ACTRN) 12615000269538.
腰痛（LBP）普遍存在，代价高昂且使人致残。对于慢性腰痛患者，建议采用包括物理治疗和认知行为疗法（CBT）在内的生物心理社会治疗方法。目前尚不清楚在线心理辅导工具是否可能在预防LBP相关残疾的二级预防中发挥作用。为了评估在慢性非特异性LBP且有持续残疾中度风险的患者中，除标准物理治疗外，互联网提供的心理项目（情绪健身房）的有效性。
对108名慢性腰痛患者（平均年龄50.4±13.6岁）进行了一项多中心随机对照试验，这些患者在六家私人理疗或脊椎按摩诊所之一就诊。在基线、治疗后（8周）以及6个月和12个月随访时，评估残疾情况（罗兰·莫里斯残疾问卷）和自我效能感（患者自我效能量表）。参与者被随机分为干预组（情绪健身房加物理治疗）或对照组（仅接受物理治疗）。
在治疗后（效应量（标准化均数差）95%置信区间）、6个月和12个月时，两组在残疾情况方面均未观察到统计学上的显著差异：罗兰·莫里斯残疾问卷分别为-0.06（-0.45,0.31）、0.01（-0.38,0.39）和-0.20（-0.62,0.17）；在自我效能感方面，治疗后患者自我效能量表为0.06（-0.31,0.45）、6个月时为0.02（-0.36,0.41）、12个月时为0.21（-0.16,0.63）。
对于慢性非特异性LBP且有持续残疾中度风险的患者，在治疗后、6个月和12个月时，互联网提供的CBT项目（情绪健身房）对物理治疗并无额外益处。
本试验已在澳大利亚新西兰临床试验注册中心（ACTRN）进行前瞻性注册，注册号为12615000269538。
