Abstract
Objectives
To systematically locate, critically appraise, and synthesize the available evidence
regarding the effectiveness of cognitive behavioral therapies (CBTs) and psychoeducation
that can be implemented by rehabilitation specialists to treat fear-avoidance beliefs
in patients with acute, subacute, and chronic low back pain (LBP).
Data Sources
Electronic databases (CINAHL, PubMed, Psychology and Behavior Sciences Collection,
SPORTDiscus, PsycINFO) were searched from inception to September 2017.
Study Selection
Assessment of methodological quality was completed using the Physiotherapy Evidence
Database (PEDro) scale. The Strength of Recommendation Taxonomy was used to evaluate
the quality of evidence.
Data Extraction
Study sample, subject demographics, CBT and/or psychoeducation intervention details,
data collection time points, outcome assessments, statistical analysis, results, and
conclusions were extracted from each study. In addition, effect sizes were calculated.
Data Synthesis
Five high-quality studies (PEDro ≥6) were included. All included studies evaluated
fear-avoidance beliefs. CBTs and psychoeducation strategies designed to target patient-specific
fears demonstrated clinically meaningful results, while psychoeducation methodologies
were not as effective.
Conclusions
There is inconsistent, patient-oriented evidence (grade B) to support the use of CBTs
and/or psychoeducation strategies by rehabilitation specialists to treat fear-avoidance
beliefs. Patient-centered and personalized CBTs were most effective to treat these
psychosocial factors in patients with LBP when compared with a control treatment.
Keywords
List of abbreviations:
CBT (cognitive behavioral therapy), CFT (cognitive functional therapy), FABQ (Fear-Avoidance Beliefs Questionnaire), FABQ-PA (Fear-Avoidance Beliefs Questionnaire–Physical Activity Subscale), FABQ-W (Fear-Avoidance Beliefs Questionnaire–Work Subscale), HSCL (Hopkins Symptom Checklist), LBP (low back pain), ODI (Oswestry Disability Index), PEDro (Physiotherapy Evidence Database), PINRS (Pain Intensity Numerical Rating Scale)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The role of fear of movement/(re) injury in pain disability.J Occup Rehabil. 1995; 5: 235-252
- A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability.Pain. 1993; 52: 157-168
- The fear-avoidance model of musculoskeletal pain: current state of scientific evidence.J Behav Med. 2007; 30: 77-94
- Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.Pain. 2000; 85: 317-332
- Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability.Pain. 1999; 80: 329-339
- The efficacy of targeted interventions for modifiable psychosocial risk factors of persistent nonspecific low back pain—a systematic review.Man Ther. 2012; 17: 385-401
- Psychological interventions in the rehabilitation of patients with chronic low back pain: evidence and recommendations from systematic reviews and guidelines.Int J Rehabil Res. 2013; 36: 6-12
- The empirical status of cognitive-behavioral therapy: a review of meta-analyses.Clin Psychol Rev. 2006; 26: 17-31
- Introduction to cognitive behavioral therapy.in: Beck J. Clinical behavioral therapy: beyond basics. Guilford Press, New York2011: 474-501
- Psychological rehabilitation from sports injuries.Sports Med. 1997; 23: 333-339
- PEDro statistics database.(Available at:)https://www.pedro.org.au/english/downloads/pedro-statistics/Date accessed: May 16, 2017
- Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature.J Am Board Fam Pract. 2004; 17: 59-67
- The effect of a fear-avoidance–based physical therapy intervention for patients with acute low back pain: results of a randomized clinical trial.Spine (Phila Pa 1976). 2003; 28: 2551-2560
- Effect of the back book on fear-avoidance beliefs, disability, and pain levels in subjects with low back pain.Int J Ther Rehabil. 2012; 19: 79-86
- Graded exercise for recurrent low-back pain: a randomized, controlled trial with 6-, 12-, and 36-month follow-ups.Spine (Phila Pa 1976). 2009; 34: 221-228
- Face-to-face information combined with a booklet versus a booklet alone for treatment of mild low-back pain: a randomized controlled trial.Scand J Work Environ Health. 2014; 40: 156-166
- Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial.Eur J Pain. 2013; 17: 916-928
Rosenthal R, Cooper H, Hedges LV. Parametric measures of effect size. In: The handbook of research synthesis. New York: Russell Sage Foundation; 1994. p 231-244.
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.Int J Surg. 2010; 8 ([published erratum appears in Int J Surg 2010;8:658]): 336-341
- The treatment of fear of movement/(re) injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo.Clin J Pain. 2002; 18: 251-261
- Efficacy of the addition of modified Pilates exercises to a minimal intervention in patients with chronic low back pain: a randomized controlled trial.Phys Ther. 2013; 93: 310-320
- Short-term effectiveness of spinal manipulative therapy versus functional technique in patients with chronic nonspecific low back pain: a pragmatic randomized controlled trial.Spine J. 2016; 16: 302-312
- Efficacy of percutaneous electrical nerve stimulation and therapeutic exercise for older adults with chronic low back pain: a randomized controlled trial.Pain. 2008; 140: 344-357
- Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain.Phys Ther. 2005; 85: 209-225
- Patient-reported outcome measures: an overview.Br J Community Nurs. 2011; 16: 146-151
- Identifying psychosocial variables in patients with acute work-related low back pain: the importance of fear-avoidance beliefs.Phys Ther. 2002; 82: 973-983
- A treatment-based classification approach to low back syndrome: identifying and staging patients for conservative treatment.Phys Ther. 1995; 75: 470-485
- The Pain Catastrophizing Scale: development and validation.Psychol Assess. 1995; 7: 524-560
- Comparison of cognitive-behavioral group treatment and an alternative non-psychological treatment for chronic low back pain.Pain. 1992; 48: 339-347
- Mindfulness meditation for the treatment of chronic low back pain in older adults: a randomized controlled pilot study.Pain. 2008; 134: 310-319
- The case for patient-centered care in orthopaedics.J Am Acad Orthop Surg. 2006; 14: 447-451
- Self-efficacy mediates the relation between pain-related fear and outcome in chronic low back pain patients.Eur J Pain. 2007; 11: 711-718
- Kinesiophobia: a new view of chronic pain behavior.Pain Manag. 1990; 3: 35-43
- The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory.Syst Res Behav Sci. 1974; 19: 1-15
Article info
Publication history
Published online: December 13, 2017
Footnotes
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
