Zhang Jiaxin, Jiang Nan, Xu Huiying, Wu Yi, Cheng Siming, Liang Bing
Department of Nursing, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, China.
School of Nursing, Jilin University, Changchun 130021, China.
Int J Nurs Stud. 2024 Mar;151:104679. doi: 10.1016/j.ijnurstu.2023.104679. Epub 2023 Dec 28.
BACKGROUND: Low back pain is a major public health problem worldwide, and there exists evidence that cognitive functional therapy may help improve patients' health condition. However, the utilization of cognitive functional therapy for low back pain is limited, and its clinical efficacy remains unclear. OBJECTIVES: To determine the efficacy of cognitive functional therapy in the management of disability, pain intensity, and fear-avoidance beliefs in low back pain patients. DESIGN: Systematic review and meta-analysis. METHOD: A comprehensive study search of Pubmed, Web of Science, Medline, CINAHL, Embase, PsycINFO, and the Cochrane Library databases was conducted from their inception to August 14th, 2023. Two researchers independently conducted the literature search and data extraction. All statistical analysis was performed using Stata Version 17.0. RESULTS: A total of eight randomized controlled trials were included. In the short-term, cognitive functional therapy significantly improved disability (7 studies, SMD = -1.05, 95 % CI = -1.74 to -0.35, I = 95.37 %, GRADE = very low), pain intensity (7 studies, SMD = -1.02, 95 % CI = -1.89 to -0.15, I = 97.21 %, GRADE = very low), and fear-avoidance beliefs (4 studies, SMD = -0.89, 95 % CI = -1.30 to -0.47, I = 82.49 %, GRADE = very low). In the medium-term, cognitive functional therapy also significantly improved disability (3 studies, SMD = -0.48, 95 % CI = -0.82 to -0.14, I = 77.97 %, GRADE = very low), pain intensity (3 studies, SMD = -0.34, 95 % CI = -0.58 to -0.10, I = 55.55 %, GRADE = very low), and fear-avoidance beliefs (2 studies, SMD = -0.62, 95 % CI = -1.19 to -0.04, I = 88.24 %, GRADE = very low). In the long-term, cognitive functional therapy significantly improved disability (4 studies, SMD = -0.54, 95 % CI = -0.95 to -0.13, I = 85.87 %, GRADE = very low) and fear-avoidance beliefs (3 studies, SMD = -0.76, 95 % CI = -1.17 to -0.34, I = 80.34 %, GRADE = very low). CONCLUSION: Cognitive functional therapy might be effective in reducing disability and fear-avoidance beliefs at any of short-, medium- and long-term follow-ups, and reducing pain at short- and medium-term follow-ups. No definitive conclusions can be drawn about the impact of cognitive functional therapy on low back pain patients due to the very low certainty evidence base. Additional rigorous randomized controlled trials are needed to further confirm these findings. REGISTRATION NUMBER: CRD42022287123 (PROSPERO).
背景：腰痛是全球主要的公共卫生问题，有证据表明认知功能疗法可能有助于改善患者的健康状况。然而，认知功能疗法在腰痛治疗中的应用有限，其临床疗效仍不明确。 目的：确定认知功能疗法对腰痛患者残疾、疼痛强度和恐惧回避信念管理的疗效。 设计：系统评价和荟萃分析。 方法：对PubMed、Web of Science、Medline、CINAHL、Embase、PsycINFO和Cochrane图书馆数据库进行全面检索，检索时间从建库至2023年8月14日。两名研究人员独立进行文献检索和数据提取。所有统计分析均使用Stata 17.0版进行。 结果：共纳入8项随机对照试验。短期内，认知功能疗法显著改善了残疾状况（7项研究，标准化均数差[SMD]= -1.05，95%置信区间[CI]= -1.74至-0.35，I²= 95.37%，证据质量等级[GRADE]=极低）、疼痛强度（7项研究，SMD = -1.02，95% CI = -1.89至-0.15，I²= 97.21%，GRADE =极低）和恐惧回避信念（4项研究，SMD = -0.89，95% CI = -1.30至-0.47，I²= 82.49%，GRADE =极低）。中期时，认知功能疗法也显著改善了残疾状况（3项研究，SMD = -0.48，95% CI = -0.82至-0.14，I²= 77.97%，GRADE =极低）、疼痛强度（3项研究，SMD = -0.34，95% CI = -0.58至-0.10，I²= 55.55%，GRADE =极低）和恐惧回避信念（2项研究，SMD = -0.62，95% CI = -1.19至-0.04，I²= 88.24%，GRADE =极低）。长期来看，认知功能疗法显著改善了残疾状况（4项研究，SMD = -0.54，95% CI = -0.95至-0.13，I²= 85.87%，GRADE =极低）和恐惧回避信念（3项研究，SMD = -0.76，95% CI = -1.17至-0.34，I²= 80.34%，GRADE =极低）。 结论：认知功能疗法在短期、中期和长期随访的任何阶段可能都对减轻残疾和恐惧回避信念有效，在短期和中期随访时对减轻疼痛有效。由于证据基础的确定性极低，关于认知功能疗法对腰痛患者的影响无法得出明确结论。需要更多严格的随机对照试验来进一步证实这些发现。 注册号：CRD42022287123（PROSPERO）
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