Review article (meta-analysis)
Evaluation of Cognitive Behavioral Interventions and Psychoeducation Implemented by Rehabilitation Specialists to Treat Fear-Avoidance Beliefs in Patients With Low Back Pain: A Systematic Review

https://doi.org/10.1016/j.apmr.2017.11.003Get rights and content

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.

Section snippets

Methods

This systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Literature search

The search and review process of articles is demonstrated in figure 1. After examining 30 articles, 513, 14, 15, 16, 17 met the inclusion criteria and were eligible for this systematic review. Of the 25 studies excluded, 20 of the studies were deemed ineligible because a rehabilitation specialist did not complete the intervention, and 1 study20 was excluded because of a crossover, randomized controlled trial study design. Four other articles21, 22, 23, 24 were excluded because their

Summary of results

The purpose of this systematic review was to evaluate the effectiveness of CBT and/or psychoeducation interventions implemented by rehabilitation specialists, compared with a control treatment, to treat fear-avoidance beliefs and/or kinesiophobia in patients with acute, subacute, or chronic LBP. Two13, 17 of 5 studies included in this systematic review demonstrated significant and clinically meaningful improvements in fear-avoidance beliefs for patients who underwent a CBT and/or

Conclusions

There is inconsistent, patient-oriented evidence (grade B) that CBT and/or psychoeducation interventions implemented by a rehabilitation specialist to treat fear-avoidance beliefs and/or kinesiophobia in patients with LBP are effective. Patient-centered interventions, such as classification-based CFT with psychosocial patient education, demonstrated favorable outcomes, while patient education techniques alone were not sufficient to reduce these psychosocial factors in this population. However,

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  • Cited by (0)

    Disclosures: none.

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