Improved outcomes with active, cognitive-behavioural, or combined treatment for LBP .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(12):206 BMC Musculoskelet Disord. 2006 Jan 20;7:5227 patients with chronic non-specific low back pain (LBP) were randomized to undergo an active rehabilitation program focused on active physical treatment, cognitive-behavioural treatment, a combination of both, or placed on a waiting list (control group). The primary outcome were subjective variables in pain and function. Results indicated that the two intervention treatments and the combined treatment were effective compared to the control group. No significant clinical differences were seen between the individual interventions and the combination group.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Randomization
3/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
Low back pain (LBP) is often treated based on three different models: the physical deconditioning model, the cognitive behavioural model and the biopsychosocial model. However, there is a lack of information between what type of treatment is most effective. This study examines the outcomes of treating patients with chronic LBP using physical active rehabilitation, cognitive-behavioural active rehabilitation, a combination of both, or none.
Qual era a principal questão de investigação?
What are the outcomes in pain and function when cognitive-behavioural active rehabilitation, physical active rehabilitation, a combination of both, or no treatment is administered in patients with chronic non-specific low back pain examined immediately post-intervention?
- All 3 intervention treatments resulted in significant reductions in functional limitations, patient's main complaints, and pain intensity compared to the waiting list control group.
- The 3 intervention treatment groups reported higher ratings in the outcomes of self-rated treatment effectiveness and satisfaction.
- No clinically relevant differences were found between the CT and APT groups, or between CT and CBT groups.
- APT and CT showed improvements in a number of physical performance tasks, while the CBT group did not.
De que é que me devo lembrar mais?
The 3 intervention treatments (active physical treatment, cognitive-behavioural treatment, and combined treatment) demonstrated better outcomes when compared to the waiting list control group. No clinically significant differences were seen when the combined intervention treatments were compared to the individual intervention treatements.
Como é que isto afectará o tratamento dos meus doentes?
Undergoing active physical treatment, cognitive-behavioural treatment, or a combined treatment of both may provided improvements in functional limitations and pain intensity for patients suffering from chronic non-specific low back pain.
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