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Cognitive treatment of illness perceptions in patients with chronic low back pain: a randomized controlled trial
Siemonsma PC, Stuive I, Roorda LD, Vollebregt JA, Walker MF, Lankhorst GJ, Lettinga AT
Physical Therapy 2013 Apr;93(4):435-448
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Illness perceptions have been shown to predict patient activities. We studied the effectiveness of a targeted illness-perception intervention on chronic non-specific low back pain (CLBP). OBJECTIVE: To compare the effectiveness of treatment of illness perceptions against a waiting list for patients with CLPB. DESIGN: A prospectively registered randomized controlled trial with an assessor blinded for group allocation. SETTING: The study was conducted in an outpatient rehabilitation clinic. PARTICIPANTS: The participants were 156 patients (18 to 70 years) with chronic (> 3 months) non-specific low back pain. INTERVENTION: Patients were randomly assigned to either the treatment group or to a waiting list. Trained physical and occupational therapists delivered 10 to 14, one hour, treatment sessions according to the treatment protocol. MEASUREMENTS: The primary outcome measure was change in patient-relevant physical activities (Patient Specific Functioning List). The secondary outcome measures were changes in illness perceptions (Illness Perceptions Questionnaire) and generic physical activity level (Quebec Back Pain Disability Scale). Measures were taken at baseline and post-treatment (0 weeks and 18 weeks). RESULTS: A baseline-adjusted analysis of covariance showed that there were statistically significant differences (p = 0.010) between intervention and control groups at 18 weeks for the change in patient-relevant physical activities. This was a clinically relevant change (19.1 mm) for the intervention group. Statistically significant differences were found for the majority of illness perception scales (p = 0.001 to 0.046). There were no significant differences in Generic physical activity levels. LIMITATIONS: Longer-term effectiveness was not studied. CONCLUSIONS: This first trial evaluating cognitive treatment of illness perceptions concerning CLBP showed statistically significant and clinically relevant improvements in patient-relevant physical activities at 18 weeks.

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