Evaluation of Cognitive Behavioral Interventions and Psychoeducation Implemented by Rehabilitation Specialists to Treat Fear-Avoidance Beliefs in Patients with Low Back Pain: A Systematic Review

Publication date: Available online 14 December 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Shelby Baez, Matthew C. Hoch, Johanna M. Hoch
ObjectiveTo systematically locate, critically appraise, and synthesize the available evidence regarding the effectiveness of cognitive behavioral therapies (CBT) and psychoeducation that can be implemented by rehabilitation specialists to treat fear-avoidance beliefs in patients with acute, sub-acute, and chronic low back pain.Data SourcesElectronic databases (CINAHL, PUBMED, PSYCHOLOGY AND BEHAVIOR SCIENCES COLLECTION, SPORTDISCUS, and PSYCH INFO) were searched from inception to September 2017.Study SelectionAssessment of methodological quality was completed utilizing the Physiotherapy Evidence Database (PEDro) scale. The Strength-of-Recommendation Taxonomy was used to evaluate the quality of evidence.Data ExtractionStudy sample, subject demographics, CBT and/or psychoeducation intervention details, data collection time points, outcome assessments, statistical analysis, results, and conclusions were extracted from each study. In addition, effect sizes were calculated.Data SynthesisFive high quality studies (PEDro >6) were included. All included studies evaluated fear-avoidance beliefs. Cognitive behavioral therapies and psychoeducation strategies designed to target patient-specific fears demonstrated clinically meaningful results, while psychoeducation methodologies were not as effective.ConclusionThere is inconsistent, patient-oriented evidence (grade B), to support the use of CBTs and/or psychoeducation strategies by rehabilitation specialists to treat fear-avoidance beliefs. Patient-centered and personalized CBTs were most effective to treat these psychosocial factors in patients with LBP when compared to a control treatment.



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