Outcome following a physiotherapist-led intervention for chronic low back pain: the important role of cognitive processes

Objectives

To examine whether patients with chronic low back pain exhibit changes in cognitive factors following Interactive Behavioural Modification Therapy (IBMT), delivered by physiotherapists; and to examine the association between pre- to post-treatment changes in cognitive factors (cognitive processes) and pre- to post-treatment changes in pain, disability and depression.

Design

Observational before-after study.

Setting

Outpatient physiotherapy department.

Participants

One hundred and thirty-seven patients with chronic low back pain.

Interventions

IBMT: ‘Work Back to Life’ rehabilitation programme.

Main outcome measures

Pre- to post-treatment changes in pain, disability and a range of cognitive factors.

Results

Patients demonstrated significant favourable changes for a range of cognitive factors. Furthermore, pre- to post-treatment changes in these cognitive factors explained an additional 22%, 17% and 15% of the variance in changes in pain, disability and depression, respectively, after controlling for other important factors.

Conclusions

Changes that emerge in cognitive factors are strongly related to treatment outcome within a physiotherapy treatment context. Specifically, reductions in fear of movement and catastrophising, and increases in functional self-efficacy appear to be particularly important. Modifying these cognitive factors should be seen as a priority when treating patients with chronic low back pain.