Avila Leonardo, da Silva Morgana Duarte, Neves Marcos Lisboa, Abreu Andre Rogerio, Fiuza Cibelle Ramos, Fukusawa Leandro, de Sá Ferreira Arthur, Meziat-Filho Ney
Postgraduate Program in Neuroscience, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
Laboratory of Neurobiology of Pain and Inflammation, Department of Physiological Sciences, Center of Biological Sciences, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
Phys Ther. 2024 Jan 1;104(1). doi: 10.1093/ptj/pzad105.
Our aim was to investigate whether cognitive functional therapy (CFT) was more effective than core exercises and manual therapy (CORE-MT) in improving pain and function for patients with chronic low back pain after spinal surgery.
This study was a randomized controlled superiority trial in a university hospital and a private physical therapist clinic in Santa Catarina, Brazil. Eighty participants who were 18 to 75 years old and had chronic low back pain after spinal surgery received 4 to 12 treatment sessions of CFT or CORE-MT once per week for a maximum period of 12 weeks. Primary outcomes were pain intensity (numeric pain rating scale, scored from 0 to 10) and function (Patient-Specific Functional Scale, scored from 0 to 10) after intervention.
We obtained primary outcome data for 75 participants (93.7%). CFT was more effective, with a large effect size, than CORE-MT in reducing pain intensity (mean difference [MD] = 2.42; 95% CI = 1.69-3.14; effect size [d] = 0.85) and improving function (MD = -2.47; 95% CI = -3.08 to -1.87; effect size = 0.95) after intervention (mean = 10.4 weeks [standard deviation = 2.17] after the beginning of treatment). The differences were maintained at 22 weeks for pain intensity (MD = 1.64; 95% CI = 0.98-2.3; effect size = 0.68) and function (MD = -2.01; 95% CI = -2.6 to -1.41; effect size = 0.81).
CFT was more effective than CORE-MT, with large effect sizes, and may be an option for patients with chronic low back pain after spinal surgery.
CFT reduces pain and improves function, with large effect sizes, compared with CORE-MT. The difference between CFT and CORE-MT was sustained at the midterm follow-up. Treatment with CFT may be an option for patients with chronic low back pain after spinal surgery.
我们的目的是研究认知功能疗法（CFT）在改善脊柱手术后慢性下腰痛患者的疼痛和功能方面是否比核心锻炼和手法治疗（CORE-MT）更有效。
本研究是在巴西圣卡塔琳娜州的一家大学医院和一家私人物理治疗诊所进行的一项随机对照优势试验。80名年龄在18至75岁之间且脊柱手术后患有慢性下腰痛的参与者接受了每周一次的CFT或CORE-MT治疗，共4至12次，最长为期12周。主要结局指标为干预后的疼痛强度（数字疼痛评分量表，评分范围为0至10）和功能（患者特异性功能量表，评分范围为0至10）。
我们获得了75名参与者（93.7%）的主要结局数据。在降低疼痛强度（平均差值[MD]=2.42；95%置信区间[CI]=1.69 - 3.14；效应量[d]=0.85）和改善功能（MD=-2.47；95%CI=-3.08至-1.87；效应量=0.95）方面，CFT比CORE-MT更有效，且效应量较大（治疗开始后平均为10.4周[标准差=2.17]）。疼痛强度（MD=1.64；95%CI=0.98 - 2.3；效应量=0.68）和功能（MD=-2.01；95%CI=-2.6至-1.41；效应量=0.81）的差异在22周时仍然存在。
CFT比CORE-MT更有效，效应量较大，可能是脊柱手术后慢性下腰痛患者的一种选择。
与CORE-MT相比，CFT能减轻疼痛并改善功能，且效应量较大。CFT与CORE-MT之间的差异在中期随访时仍然存在。CFT治疗可能是脊柱手术后慢性下腰痛患者的一种选择。
