Thursday, December 01, 2016 Study: Research Indicates PT-Delivered CB Interventions Work for LBP – But Can They be Translated to Practice? Researchers from England are confident that when physical therapists (PTs) add cognitive behavioral (CB) interventions to their treatment of patients with back pain, outcomes improve—especially for individuals with long-term disability. But when it comes to what, exactly, those CB interventions should be, how they can be replicated in practice, and how PTs can acquire adequate training on them … things start to get a little less certain. In a systematic review published in Disability and Rehabilitation (abstract only available for free), researchers analyzed data from 5 randomized controlled trials involving 1,390 participants with nonspecific low back pain (LBP). Each study compared an "active treatment" including education and "standard physiotherapy interventions" (as recommended in the European Guidelines for LBP) with PT-delivered CB interventions used as a primary treatment component. Studies that used passive, pharmacological, or invasive interventions such as surgery were excluded. Researchers looked at data from patient-reported questionnaires and found high-quality evidence that the use of CB interventions was effective in reducing disability, though the impact on quality of life was found to be statistically insignificant. The most powerful effects were recorded in participants with long-term disability and long-term pain; individuals with short-term pain and disability reported smaller effects when CB interventions were used. According to the study's authors, all PT-led CB interventions were aimed at "increasing physical activity and coping skills, [and] modifying unhelpful beliefs associated with pain such as thoughts that their pain will never get better or it is indicative of a more serious spinal condition." The duration and session schedules were roughly similar—6 to 8 sessions over a 4 to 6 weeks, with session duration ranging from 30 minutes to 2 hours. Two studies used a 1-on-1 approach; 3 used groups (group size varied from 4 to 10). Researchers were satisfied that the PT-led CB interventions were effective but noted that the studies they reviewed begged a few big questions: namely, what, exactly did these PTs do during their interventions, how did they learn how to do it, and what's the likelihood that these interventions could be replicated in a clinical setting? While authors were able to identify common CB techniques used by all the studies—CB-related education, cognitive restructuring, activity pacing, and relaxation techniques—they noted that specific methods varied. To cloud matters even further, they write, "we found no information on how to replicate the procedural content of these interventions in practice. Without this information, successful translation of evidence-based CB interventions in physiotherapy practice is more difficult." "Importantly, our results support the conclusion that, with some additional training, physiotherapists can deliver CB interventions to treat patients with LBP and achieve sustained reductions in pain and disability over the long-term," authors write. However, they include a caveat: "For this approach to be translated into practice, access to additional training (as was provided in the included studies) is necessary for physiotherapists who work in clinical practice. It is likely that without training and access to the requisite manuals and materials in a manner that is affordable and accessible on a large scale, these interventions would not be successfully replicated into practice." And that's where researchers come in, according to the review's authors. "There is inadequate information in the studies on how to implement the evidence-based CB interventions in clinical practice," they write. "We recommend firstly that researchers improve the level of reporting on intervention procedures and secondly that appropriate training should be accessible to build training in CB interventions." Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.