Reasons for Variation in the Effectiveness of Cognitive Behavioural Therapy (CBT) in Physiotherapy Management for Chronic Low Back Pain (CLBP): Mixed Methods Systematic Review
Background: Chronic Low Back Pain (CLBP) is one of the most common and recurrent musculoskeletal problems that causes patients to frequently access healthcare services. The Bio-psychosocial model emphasizes that psychological, behavioural and social factors contribute to the development and persistence of CLBP. Cognitive behavioural therapy (CBT) is a psychological pain management strategy that can be used by physiotherapists treating CLBP. However, the effectiveness of CBT for CLBP varies between different studies.
• To identify studies exploring or explaining the process of implementing CBT in physiotherapy management for CLBP.
• To explore the reasons of variation in the effectiveness of CBT.
• To identify knowledge gaps in this area.
Methods: Quantitative, qualitative or mixed methods studies using CBT to manage CLBP patients were searched systematically until May 2014. The electronic search was done using the following databases CINAHL plus full text, MEDLINE via Ovid, Cochrane library, Scopus, Pub Med, Web of science, ASSIA and Psych info. All full text studies published in peer review journals were assessed for eligibility. Data extraction was based on population, intervention, comparison and outcome (PICO). Methodological quality and clinical relevance of included studies were assessed.
Results: Thirty- seven studies were included. There were 36 quantitative studies, and one qualitative study as part of a mixed methods study. A qualitative (narrative) analysis was considered due to lack of homogeneity among studies. The majority of studies (24 of 37 studies) had high methodological quality and were considered of moderate -to- high clinically relevance.
Conclusion: Studies were so heterogeneous it was not possible to account for differences in treatment effect. Key differences between studies were study design, setting, and outcome measures. There were no qualitative studies exploring how CBT is effective for CLBP or explaining the reasons for variation in CBT effectiveness. Further research is required to explore perceptions of CBT in physiotherapy.
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