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Cited by 163Musculoskeletal pain and rehabilitationHealth Policy Implementation SciencePain Management and Treatment

Physiotherapist-delivered cognitive-behavioural interventions are effective for low back pain, but can they be replicated in clinical practice? A systematic review

Open access
Hall, Amanda, Richmond, Helen, Copsey, Bethan, Hansen, Zara, Williamson, Esther, Jones, Gillian, Fordham, Beth, Cooper, Zafra +1 more·2018·Disability and Rehabilitation
DOI 10.1080/09638288.2016.1236155
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Abstract

PURPOSE: To determine if physiotherapist-led cognitive-behavioural (CB) interventions are effective for low back pain (LBP) and described sufficiently for replication. METHOD: Randomised controlled trials (RCTs) of patients with LBP treated by physiotherapists using a CB intervention were included. Outcomes of disability, pain, and quality of life were assessed using the GRADE approach. Intervention reporting was assessed using the Template for Intervention Description and Replication. RESULTS: Of 1898 titles, 5 RCTs (n = 1390) were identified. Compared to education and/or exercise interventions, we found high-quality evidence that CB had a greater effect (SMD; 95% CI) on reducing disability (-0.19; -0.32, -0.07), pain (-0.21; -0.33, -0.09); and moderate-quality evidence of little difference in quality of life (-0.06; -0.18 to 0.07). Sufficient information was provided on dose, setting, and provider; but not content and procedural information. Studies tended to report the type of CB component used (e.g., challenging unhelpful thoughts) with little detail on how it was operationalised. Moreover, access to treatment manuals, patient materials and provider training was lacking. CONCLUSIONS: With additional training, physiotherapists can deliver effective CB interventions. However, without training or resources, successful translation and implementation remains unlikely. Researchers should improve reporting of procedural information, provide relevant materials, and offer accessible provider training. Implications for Rehabilitation Previous reviews have established that traditional biomedical-based treatments (e.g., acupuncture, manual therapy, massage, and specific exercise programmes) that focus only on physical symptoms do provide short-term benefits but the sustained effect is questionable. A cognitive-behavioural (CB) approach includes techniques to target both physical and psychosocial symptoms related to pain and provides patients with long-lasting skills to manage these symptoms on their own. This combined method has been used in a variety of settings delivered by different health care professionals and has been shown to produce long-term effects on patient outcomes. What has been unclear is if these programmes are effective when delivered by physiotherapists in routine physiotherapy settings. Our study synthesises the evidence for this context. We have confirmed with high-quality evidence that with additional training, physiotherapists can deliver CB interventions that are effective for patients with back pain. Physiotherapists who are considering enhancing their treatment for patients with low back pain should consider undertaking some additional training in how to incorporate CB techniques into their practice to optimise treatment benefits and help patients receive long-lasting treatment effects. Importantly, our results indicate that using a CB approach, including a variety of CB techniques that could be easily adopted in a physical therapy setting, provides greater benefits for patient outcomes compared to brief education, exercise or physical techniques (such as manual therapy) alone. This provides further support that a combined treatment approach is likely better than one based on physical techniques alone. Notably, we identified a significant barrier to adopting any of these CB interventions in practice. This is because no study provided a description of the intervention or accessible training materials that would allow for accurate replication. Without access to provider training and/or resources, we cannot expect this evidence to be implemented in practice with optimal effects. Thus, we would urge physiotherapists to directly contact authors of the studies for more information on how to incorporate their interventions into their settings.

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Authors
Hall, A., Richmond, H., Copsey, B., Hansen, Z., Williamson, E., Jones, G., Fordham, B., Cooper, Z., & Lamb, S.
Affiliations
  • The George Institute for Global Health (GB)
  • University of Oxford (GB)
Corresponding author
Hall, Amanda
ORCID
Venue
Disability and Rehabilitation
Publisher
Informa UK Limited
Published
2016-11-21
Volume
40
Issue
1
Pages
1-9
ISSN
  • 0963-8288 (ISSN-L)
  • 1464-5165
DOI
10.1080/09638288.2016.1236155
OpenAlex
W2553078412
Cited by
163
References
27
Citations by year
2026: 3 · 2025: 15 · 2024: 13 · 2023: 13 · 2022: 24 · 2021: 30 · 2020: 23 · 2019: 22 · 2018: 17 · 2017: 2 · 2016: 1
FWCI
1.60
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Disability and Rehabilitation (publishedVersion)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion, cc-by)
  • Figshare (cc-by)
Funders
National Institute for Health and Care Research (01/75/01)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords
low back pain, cognitive-behavioural intervention, physiotherapists, intervention replication, intervention reporting quality, provider training, disability, pain, quality of life, exercise intervention, educational intervention, clinical translation, treatment manual
MeSH terms
Combined Modality Therapy, Delivery of Health Care, Humans, Cognitive Behavioral Therapy, Low Back Pain, Physical Therapy Modalities, Physical Therapists

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