Physiotherapy‐provided operant conditioning in the management of low back pain disability: A systematic review
Abstract
Background and Purpose. Non‐specific low back pain (LBP) is a leading cause of disability in developed countries. Behavioural interventions have been found efficacious in reducing disability in LBP. Operant conditioning is one type of behavioural intervention being employed by physiotherapists; however, the effectiveness of physiotherapist‐provided operant conditioning (POC) in the management of LBP disability is unknown. This review aims to answer the question: is POC more effective than comparison interventions in reducing LBP disability? Method. A systematic review of randomized controlled trials was conducted using a qualitative analysis of effect. Participants were adults ≥18 years with non‐specific LBP. The intervention was defined as a time contingent, graduated increase in activity including goal setting and the education and reinforcement of positive pain behaviours with the aim of decreasing disability. The primary outcome measure was back pain specific disability. Secondary outcomes included generic functional status, pain intensity, sick leave, fear avoidance beliefs or behaviour and adverse effects. Results. Fifteen trials involving 3737 people were included. Eight studies reported a clinically significant difference. The POC intervention was not found to be inferior to any of the comparison interventions in reducing disability. Moderate evidence was found that POC is more effective than other behavioural interventions in reducing long term disability in chronic LBP. Moderate evidence showed POC may be more effective than other treatments in reducing post‐treatment fear avoidance beliefs in a sub‐acute population but less effective in reducing short term fear avoidance beliefs in a population with mixed LBP. Moderate evidence showed POC is more effective than a placebo intervention in reducing short term pain in sub‐acute LBP. Conclusion. POC may be considered efficacious in the treatment of LBP. Physiotherapists may also consider POC for its additional effect of reducing long term disability in chronic LBP. Copyright © 2010 John Wiley & Sons, Ltd.
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Four reviews focused specifically on cognitive and/or behaviour-based approaches that were delivered by non-psychologists.
“Four reviews focused specifically on cognitive and/or behaviour-based approaches that were delivered by non-psychologists.50 61 64 82”
From Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: A scoping review of systematic reviews (2024) · cites this paper as [64]
Four reviews focused specifically on cognitive and/or behaviour-based approaches that were delivered by non-psychologists, such as physiotherapists and other rehabilitation-focussed allied health clinicians.
“In systematic reviews of psychological interventions, clinicians delivering interventions were typically psychologists, however, four reviews focused specifically on cognitive and/or behaviour-based approaches that were delivered by non-psychologists, such as physiotherapists and other rehabilitation-focussed allied health clinicians.50 61 64 82”
From Impact of healthcare interventions on distress following acute musculoskeletal/orthopaedic injury: A scoping review of systematic reviews (2024) · cites this paper as [64]
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Background
- Authors
- Bunzli, S., Gillham, D., & Esterman, A.
- Affiliations
- University of South Australia (AU)
- Corresponding author
- Bunzli, Samantha
- Venue
- Physiotherapy Research International
- Publisher
- Wiley
- Published
- 2011-02-16
- Volume
- 16
- Issue
- 1
- Pages
- 4-19
- ISSN
- 1358-2267 (ISSN-L)
- 1471-2865
- OpenAlex
- W2112644811
- Cited by
- 61
- References
- 45
- Citations by year
- 2025: 3 · 2024: 5 · 2022: 4 · 2021: 9 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 6 · 2016: 4 · 2015: 4 · 2014: 4 · 2012: 8
- FWCI
- 0.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Physiotherapy Research International (publishedVersion)
- PubMed (publishedVersion)
- ResearchOnline - JCU (James Cook University) (submittedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- non-specific low back pain, operant conditioning, physiotherapy, disability, behavioral interventions, fear-avoidance beliefs, pain intensity, sick leave, chronic low back pain, subacute low back pain, goal setting
- MeSH terms
- Conditioning, Operant, Female, Persons with Disabilities, Humans, Male, Meta-Analysis as Topic, Randomized Controlled Trials as Topic, Treatment Outcome, Low Back Pain, Physical Therapy Modalities
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