Comparative Effectiveness of Conservative Interventions for Nonspecific Chronic Spinal Pain: Physical, Behavioral/Psychologically Informed, or Combined? A Systematic Review and Meta-Analysis

Abstract

Non-specific chronic spinal pain (NSCSP) is highly disabling. Current conservative rehabilitation commonly includes physical and behavioural interventions, or a combination of these approaches. Physical interventions aim to enhance physical capacity by using methods such as exercise, manual therapy and ergonomics. Behavioural and/or psychologically informed interventions aim to enhance behaviours, cognitions or mood by using methods such as relaxation and cognitive behavioural therapy (CBT). Combined interventions aim to target both physical and behavioural and/or psychological factors contributing to patients' pain by using methods such as multidisciplinary pain management programmes. Since it remains unclear whether any of these approaches are superior, this review aimed to assess the comparative effectiveness of physical, behavioural and/or psychologically informed, and combined interventions on pain and disability in patients with NSCSP. Nine electronic databases were searched for randomised controlled trials (RCTs) including participants reporting NSCSP. Studies were required to have an "active" conservative treatment control group for comparison. Studies were not eligible if the interventions were from the same domain (e.g. if the study compared two physical interventions). Study quality was assessed used the Cochrane Back Review Group risk of bias criteria. The treatment effects of physical, behavioural and/or psychologically informed, and combined interventions were assessed using meta-analyses. 24 studies were included. No clinically significant differences were found for pain and disability between physical, behavioural and/or psychologically informed and combined interventions. The simple categorisation of interventions into physical, behavioural and/or psychologically informed and combined could be considered a limitation of this review, as these interventions may not be easily differentiated to allow accurate comparisons to be made. Further work should consider investigating whether tailoring Perspective: In this systematic review of RCTs in NSCSP, only small differences in pain or disability were observed between physical, behavioural and/or psychologically informed and combined interventions.

Manipulating practices: A critical physiotherapy reader

“…It is not the purpose of this chapter to provide a detailed review of the evidence of therapeutic effectiveness for therapeutic touch. However, for the purpose of our argument we can surmise that such evidence leads us to believe that in terms of commonly utilised health outcomes, touch-based therapies might not be as comparatively effective as once thought (for example O'Keeffe et al, 2016) 2 . The effect of this belief extends to the recommendation that utility of touch-based therapies is seriously questioned in the management of many painful and movement dysfunctions (e.g.…”

Eficacia de un Tratamiento Cognitivo Comportamental (TCC) con apoyo de Tecnologías de la Información y la Comunicación (TICs) para el dolor lumbar crónico. Ensayo clínico aleatorizado

“…El objetivo final es mejorar conductas, pensamientos y el estado de ánimo (O'Keeffe et al, 2016). Para ello, las intervenciones cognitivo conductuales (TCC) han demostrado ser eficaces en disminuir el dolor y la discapacidad y, en menor medida, mejorar el estado de ánimo y la catastrofización en pacientes con dolor crónico en comparación con un grupo control o de tratamiento habitual.…”

“…Las intervenciones físicas tienen como objetivo mejorar la capacidad funcional empleando métodos tales como ejercicio, terapia manual y ergonomía (O'Keeffe et al, 2016), tal y como hemos visto. Sin embargo, ya en 1974, Hall propuso una Escuela de Espalda dirigida a pacientes crónicos con patología lumbar en la que se incluía el abordaje psicológico del problema (Hall, 1980;Hall et al, 1983).…”

“…Además, la ambigüedad para poder determinar la etiología de este síndrome, así como la inconsistencia de los resultados de los tratamientos basados en aspectos puramente orgánicos, hacen suponer que en el desarrollo del DLC pueden participar factores que no son exclusivamente físicos (Bravo y González-Durán, 2001). Es por eso, que es recomendable incorporar una 67 intervención psicológica para estos pacientes y, con ello, darles un tratamiento más adecuado y completo.Las intervenciones físicas tienen como objetivo mejorar la capacidad funcional empleando métodos tales como ejercicio, terapia manual y ergonomía (O'Keeffe et al, 2016), tal y como hemos visto. Sin embargo, ya en 1974, Hall propuso una Escuela de Espalda dirigida a pacientes crónicos con patología lumbar en la que se incluía el abordaje psicológico del problema (Hall, 1980;Hall et al, 1983).…”

“…Esta parte de la intervención va dirigida a controlar los pensamientos y emociones negativas, y a desarrollar conductas adaptativas de afrontamiento ante el dolor que permitan la reinterpretación del mismo y la convivencia con él, fomentando el desarrollo de la calidad de vida (Casado et al, 2008). De esta forma, la intervención psicológica persigue mejorar conductas, cogniciones y el estado de ánimo a través de relajación y terapia cognitivo conductual (O'Keeffe et al, 2016).…”