Delivering an Optimised Behavioural Intervention (OBI) to people with low back pain with high psychological risk: results and lessons learnt from a feasibility randomised controlled trial of Contextual Cognitive Behavioural Therapy (CCBT) vs. Physiotherapy
Delivering an Optimised Behavioural Intervention (OBI) to people with low back pain with high psychological risk: results and lessons learnt from a feasibility randomised controlled trial of Contextual Cognitive Behavioural Therapy (CCBT) vs. Physiotherapy
BackgroundLow Back Pain (LBP) remains a common and costly problem. Psychological obstacles to recovery have been identified, but psychological and behavioural interventions have produced only moderate improvements. Reviews of trials have suggested that the interventions lack clear theoretical basis, are often compromised by low dose, lack of fidelity, and delivery by non-experts. In addition, interventions do not directly target known risk mechanisms. We identified a theory driven intervention (Contexual Cognitive Behavioural Therapy, CCBT) that directly targets an evidence-based risk mechanism (avoidance and ensured dose and delivery were optimised. This feasibility study was designed to test the credibility and acceptability of optimised CCBT against physiotherapy for avoidant LBP patients, and to test recruitment, delivery of the intervention and response rates prior to moving to a full definitive trial.MethodsA randomised controlled feasibility trial with patients randomised to receive CCBT or physiotherapy. CCBT was delivered by trained supervised psychologists on a one to one basis and comprised up to 8 one-hour sessions. Physiotherapy comprised back to fitness group exercises with at least 60 % of content exercise-based. Patients were eligible to take part if they had back pain for more than 3 months, and scored above a threshold indicating fear avoidance, catastrophic beliefs and distress.Results89 patients were recruited. Uptake rates were above those predicted. Scores for credibility and acceptability of the interventions met the set criteria. Response rates at three and six months fell short of the 75 % target. Problems associated with poor response rates were identified and successfully resolved, rates increased to 77 % at 3 months, and 68 % at 6 months. Independent ratings of treatment sessions indicated that CCBT was delivered to fidelity. Numbers were too small for formal analysis. Although average scores for acceptance were higher in the CCBT group than in the group attending physiotherapy (increase of 7.9 versus 5.1) and change in disability and pain from baseline to 6 months were greater in the CCBT group than in the physiotherapy group, these findings should be interpreted with caution.ConclusionsCCBT is a credible and acceptable intervention for LBP patients who exhibit psychological obstacles to recovery.
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
Anwar, Shamaila
515f63aa-15a4-4efa-94c0-24001e5a7cff
McCracken, Lance
af8fedee-f2f6-4721-8cc6-7e3f209b4ec0
McGregor, Alison
fccf158f-85b0-4333-98f2-55bec69c5d94
Graham, Liz
6038a389-2fd8-4e65-9ed1-54a6940a45aa
OBI Trial Management Team, Clinical Trials Research Unit, University of Leeds, UK
16 June 2015
Pincus, Tamar
55388347-5d71-4fc0-9fd2-66fbba080e0c
Anwar, Shamaila
515f63aa-15a4-4efa-94c0-24001e5a7cff
McCracken, Lance
af8fedee-f2f6-4721-8cc6-7e3f209b4ec0
McGregor, Alison
fccf158f-85b0-4333-98f2-55bec69c5d94
Graham, Liz
6038a389-2fd8-4e65-9ed1-54a6940a45aa
Graham, Liz
,
OBI Trial Management Team, Clinical Trials Research Unit, University of Leeds, UK
(2015)
Delivering an Optimised Behavioural Intervention (OBI) to people with low back pain with high psychological risk: results and lessons learnt from a feasibility randomised controlled trial of Contextual Cognitive Behavioural Therapy (CCBT) vs. Physiotherapy.
BMC Musculoskeletal Disorders, 16 (6), [147].
(doi:10.1186/s12891-015-0594-2).
Abstract
BackgroundLow Back Pain (LBP) remains a common and costly problem. Psychological obstacles to recovery have been identified, but psychological and behavioural interventions have produced only moderate improvements. Reviews of trials have suggested that the interventions lack clear theoretical basis, are often compromised by low dose, lack of fidelity, and delivery by non-experts. In addition, interventions do not directly target known risk mechanisms. We identified a theory driven intervention (Contexual Cognitive Behavioural Therapy, CCBT) that directly targets an evidence-based risk mechanism (avoidance and ensured dose and delivery were optimised. This feasibility study was designed to test the credibility and acceptability of optimised CCBT against physiotherapy for avoidant LBP patients, and to test recruitment, delivery of the intervention and response rates prior to moving to a full definitive trial.MethodsA randomised controlled feasibility trial with patients randomised to receive CCBT or physiotherapy. CCBT was delivered by trained supervised psychologists on a one to one basis and comprised up to 8 one-hour sessions. Physiotherapy comprised back to fitness group exercises with at least 60 % of content exercise-based. Patients were eligible to take part if they had back pain for more than 3 months, and scored above a threshold indicating fear avoidance, catastrophic beliefs and distress.Results89 patients were recruited. Uptake rates were above those predicted. Scores for credibility and acceptability of the interventions met the set criteria. Response rates at three and six months fell short of the 75 % target. Problems associated with poor response rates were identified and successfully resolved, rates increased to 77 % at 3 months, and 68 % at 6 months. Independent ratings of treatment sessions indicated that CCBT was delivered to fidelity. Numbers were too small for formal analysis. Although average scores for acceptance were higher in the CCBT group than in the group attending physiotherapy (increase of 7.9 versus 5.1) and change in disability and pain from baseline to 6 months were greater in the CCBT group than in the physiotherapy group, these findings should be interpreted with caution.ConclusionsCCBT is a credible and acceptable intervention for LBP patients who exhibit psychological obstacles to recovery.
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Accepted/In Press date: 22 May 2015
Published date: 16 June 2015
Identifiers
Local EPrints ID: 469121
URI: http://eprints.soton.ac.uk/id/eprint/469121
ISSN: 1471-2474
PURE UUID: 5e27be3f-900b-4f24-b9fb-ff2ca8a16b54
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Date deposited: 06 Sep 2022 20:27
Last modified: 17 Mar 2024 04:11
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Contributors
Author:
Tamar Pincus
Author:
Shamaila Anwar
Author:
Lance McCracken
Author:
Alison McGregor
Author:
Liz Graham
Corporate Author: OBI Trial Management Team, Clinical Trials Research Unit, University of Leeds, UK
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