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Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis

OBJECTIVE: To determine the comparative effectiveness and safety of psychological interventions for chronic low back pain. DESIGN: Systematic review with network meta-analysis. DATA SOURCES: Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, and CINAHL...

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Autores principales: Ho, Emma Kwan-Yee, Chen, Lingxiao, Simic, Milena, Ashton-James, Claire Elizabeth, Comachio, Josielli, Wang, Daniel Xin Mo, Hayden, Jill Alison, Ferreira, Manuela Loureiro, Ferreira, Paulo Henrique
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8965745/
https://www.ncbi.nlm.nih.gov/pubmed/35354560
http://dx.doi.org/10.1136/bmj-2021-067718
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author Ho, Emma Kwan-Yee
Chen, Lingxiao
Simic, Milena
Ashton-James, Claire Elizabeth
Comachio, Josielli
Wang, Daniel Xin Mo
Hayden, Jill Alison
Ferreira, Manuela Loureiro
Ferreira, Paulo Henrique
author_facet Ho, Emma Kwan-Yee
Chen, Lingxiao
Simic, Milena
Ashton-James, Claire Elizabeth
Comachio, Josielli
Wang, Daniel Xin Mo
Hayden, Jill Alison
Ferreira, Manuela Loureiro
Ferreira, Paulo Henrique
author_sort Ho, Emma Kwan-Yee
collection PubMed
description OBJECTIVE: To determine the comparative effectiveness and safety of psychological interventions for chronic low back pain. DESIGN: Systematic review with network meta-analysis. DATA SOURCES: Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, and CINAHL from database inception to 31 January 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Randomised controlled trials comparing psychological interventions with any comparison intervention in adults with chronic, non-specific low back pain. Two reviewers independently screened studies, extracted data, and assessed risk of bias and confidence in the evidence. Primary outcomes were physical function and pain intensity. A random effects network meta-analysis using a frequentist approach was performed at post-intervention (from the end of treatment to <2 months post-intervention); and at short term (≥2 to <6 months post-intervention), mid-term (≥6 to <12 months post-intervention), and long term follow-up (≥12 months post-intervention). Physiotherapy care was the reference comparison intervention. The design-by-treatment interaction model was used to assess global inconsistency and the Bucher method was used to assess local inconsistency. RESULTS: 97 randomised controlled trials involving 13 136 participants and 17 treatment nodes were included. Inconsistency was detected at short term and mid-term follow-up for physical function, and short term follow-up for pain intensity, and were resolved through sensitivity analyses. For physical function, cognitive behavioural therapy (standardised mean difference 1.01, 95% confidence interval 0.58 to 1.44), and pain education (0.62, 0.08 to 1.17), delivered with physiotherapy care, resulted in clinically important improvements at post-intervention (moderate quality evidence). The most sustainable effects of treatment for improving physical function were reported with pain education delivered with physiotherapy care, at least until mid-term follow-up (0.63, 0.25 to 1.00; low quality evidence). No studies investigated the long term effectiveness of pain education delivered with physiotherapy care. For pain intensity, behavioural therapy (1.08, 0.22 to 1.94), cognitive behavioural therapy (0.92, 0.43 to 1.42), and pain education (0.91, 0.37 to 1.45), delivered with physiotherapy care, resulted in clinically important effects at post-intervention (low to moderate quality evidence). Only behavioural therapy delivered with physiotherapy care maintained clinically important effects on reducing pain intensity until mid-term follow-up (1.01, 0.41 to 1.60; high quality evidence). CONCLUSIONS: For people with chronic, non-specific low back pain, psychological interventions are most effective when delivered in conjunction with physiotherapy care (mainly structured exercise). Pain education programmes (low to moderate quality evidence) and behavioural therapy (low to high quality evidence) result in the most sustainable effects of treatment; however, uncertainty remains as to their long term effectiveness. Although inconsistency was detected, potential sources were identified and resolved. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019138074.
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spelling pubmed-89657452022-04-19 Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis Ho, Emma Kwan-Yee Chen, Lingxiao Simic, Milena Ashton-James, Claire Elizabeth Comachio, Josielli Wang, Daniel Xin Mo Hayden, Jill Alison Ferreira, Manuela Loureiro Ferreira, Paulo Henrique BMJ Research OBJECTIVE: To determine the comparative effectiveness and safety of psychological interventions for chronic low back pain. DESIGN: Systematic review with network meta-analysis. DATA SOURCES: Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, and CINAHL from database inception to 31 January 2021. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Randomised controlled trials comparing psychological interventions with any comparison intervention in adults with chronic, non-specific low back pain. Two reviewers independently screened studies, extracted data, and assessed risk of bias and confidence in the evidence. Primary outcomes were physical function and pain intensity. A random effects network meta-analysis using a frequentist approach was performed at post-intervention (from the end of treatment to <2 months post-intervention); and at short term (≥2 to <6 months post-intervention), mid-term (≥6 to <12 months post-intervention), and long term follow-up (≥12 months post-intervention). Physiotherapy care was the reference comparison intervention. The design-by-treatment interaction model was used to assess global inconsistency and the Bucher method was used to assess local inconsistency. RESULTS: 97 randomised controlled trials involving 13 136 participants and 17 treatment nodes were included. Inconsistency was detected at short term and mid-term follow-up for physical function, and short term follow-up for pain intensity, and were resolved through sensitivity analyses. For physical function, cognitive behavioural therapy (standardised mean difference 1.01, 95% confidence interval 0.58 to 1.44), and pain education (0.62, 0.08 to 1.17), delivered with physiotherapy care, resulted in clinically important improvements at post-intervention (moderate quality evidence). The most sustainable effects of treatment for improving physical function were reported with pain education delivered with physiotherapy care, at least until mid-term follow-up (0.63, 0.25 to 1.00; low quality evidence). No studies investigated the long term effectiveness of pain education delivered with physiotherapy care. For pain intensity, behavioural therapy (1.08, 0.22 to 1.94), cognitive behavioural therapy (0.92, 0.43 to 1.42), and pain education (0.91, 0.37 to 1.45), delivered with physiotherapy care, resulted in clinically important effects at post-intervention (low to moderate quality evidence). Only behavioural therapy delivered with physiotherapy care maintained clinically important effects on reducing pain intensity until mid-term follow-up (1.01, 0.41 to 1.60; high quality evidence). CONCLUSIONS: For people with chronic, non-specific low back pain, psychological interventions are most effective when delivered in conjunction with physiotherapy care (mainly structured exercise). Pain education programmes (low to moderate quality evidence) and behavioural therapy (low to high quality evidence) result in the most sustainable effects of treatment; however, uncertainty remains as to their long term effectiveness. Although inconsistency was detected, potential sources were identified and resolved. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019138074. BMJ Publishing Group Ltd. 2022-03-30 /pmc/articles/PMC8965745/ /pubmed/35354560 http://dx.doi.org/10.1136/bmj-2021-067718 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Research
Ho, Emma Kwan-Yee
Chen, Lingxiao
Simic, Milena
Ashton-James, Claire Elizabeth
Comachio, Josielli
Wang, Daniel Xin Mo
Hayden, Jill Alison
Ferreira, Manuela Loureiro
Ferreira, Paulo Henrique
Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis
title Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis
title_full Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis
title_fullStr Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis
title_full_unstemmed Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis
title_short Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis
title_sort psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8965745/
https://www.ncbi.nlm.nih.gov/pubmed/35354560
http://dx.doi.org/10.1136/bmj-2021-067718
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