New research sought to determine the long-term effects of physical therapy on patients with chronic low back pain.
In a study of physio Adelaide for chronic low back pain (CLBP), researchers found that the benefits of a clinical reasoning approach with a physical therapy prescription were maintained at a 2-year follow-up. “There is a great deal of emphasis on early intervention for CLBP, yet there has been little investigation into how to maintain benefits over time best,” said lead author Kimberly L. Hathaway, PT, DPT, PhD, of the University at Buffalo, State University of New York. “As a result, patient expectations change, and they often report deterioration in function over time.”
The authors note that CLBP affects 12 percent to 15 percent of adults worldwide and is the primary cause of disability in working-age populations. While numerous evidence-based treatments for CLBP exist, the long-term benefits of these physio Adelaide treatments are not well established. For example, drug therapy can assist with pain control but does not alter any underlying pathophysiologic mechanisms. Cognitive-behavioural therapy (CBT) can reduce disability and pain, but often only for short periods.
“The primary aim of physical therapy regarding CLBP is to assist patients in regaining their ability to function,” the authors write. “Thus, physical therapists should be aware of developing treatment interventions that can maintain long-term patient outcomes.”
To investigate this issue, Hathaway and colleagues performed a secondary analysis of data from an earlier trial (JAMA, 2007) that examined the effects of adding CBT to a clinical reasoning strategy (CRS) compared with using CRS alone in patients with CLBP.
“This study differs from many others that have evaluated the effectiveness of various treatments for CLBP,” they write. “Most studies use randomized controlled trials (RCTs), which provide the most powerful study design, but few RCTs have been conducted with patients with CLBP.”
In this earlier trial, the CRS approach decreased pain and disability from baseline to post-treatment. CBT also reduced pain intensity and disability, but only in the short term. At 26-week follow-up, there was a decline in outcomes for both treatment groups. In this current study, Hathaway and colleagues elected to evaluate the outcomes using analysis of covariance (ANCOVA) at a 2-year follow-up.
“We wanted to look at how well patients were faring, or if they had maintained any benefits, after engaging in treatments for CLBP,” Hathaway said. “There was no reported data set that could be used for this type of study. So we decided to access the original trial data and perform a secondary analysis.”
The study included 159 individuals who were randomly assigned to 1 of 3 treatment conditions: CRS alone (n = 52); CBT plus CRS (n = 55); or usual care, which was defined as general practitioner management in the community (n = 52). The researchers administered the Oswestry Low Back Pain Disability Questionnaire to all participants. At a 2-year follow-up, they found that both treatment groups had significant improvements in disability scores at each assessment compared with the control group.
“This finding was important because it demonstrated that patients were still receiving some benefit from their treatments,” Hathaway said. “We were also able to determine that the magnitude of benefit from CBT at 2-year follow-up was similar to that reported at 26 weeks, which is clinically meaningful.”
In addition, results showed both treatment groups maintained their improvements in disability. All three groups showed a reduction in pain intensity over time. Still, this reduction was more significant in the treatment groups than in the control group at all follow-up assessments. Furthermore, both treatment groups maintained their improvements in disability compared with baseline at 26 weeks and two years, while the control group demonstrated a return to baseline status.
“These results indicate that even after an entire course of CBT, patients show a significant reduction in disability,” the authors write. The researchers also found that at a 2-year follow-up, both treatment groups had a significantly lower pain intensity than the control group did.