Mark Hancock , Anne Smith , Peter O’Sullivan , Robert Schütze , JP Caneiro , Jan Hartvigsen , Kieran O’Sullivan , Alison McGregor , Terry Haines , Alistair Vickery , Amity Campbell , Peter Kent
{"title":"对慢性腰背痛认知功能疗法反应最佳的是残疾程度更严重的患者：随机试验的预先计划二次分析。","authors":"Mark Hancock , Anne Smith , Peter O’Sullivan , Robert Schütze , JP Caneiro , Jan Hartvigsen , Kieran O’Sullivan , Alison McGregor , Terry Haines , Alistair Vickery , Amity Campbell , Peter Kent","doi":"10.1016/j.jphys.2024.08.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Question</h3><div>Do five baseline moderators identify patients with chronic low back pain who respond best to cognitive functional therapy (CFT) when compared with usual care?</div></div><div><h3>Design</h3><div>Secondary analysis of the RESTORE randomised controlled trial.</div></div><div><h3>Participants</h3><div>A total of 492 adults with low back pain for > 3 months with at least moderate pain-related activity limitation.</div></div><div><h3>Intervention</h3><div>Participants were allocated to CFT alone or CFT plus biofeedback; these two groups were combined for this secondary analysis. The control group was usual care.</div></div><div><h3>Outcome measures</h3><div>The outcome was activity limitation measured using the Roland Morris Disability Questionnaire (RMDQ) at 3, 6, 13, 26, 40 and 52 weeks. Investigated effect modifiers were baseline measures of activity limitation, cognitive flexibility, pain intensity, self-efficacy and catastrophising.</div></div><div><h3>Results</h3><div>Baseline levels of activity limitation and, potentially, cognitive flexibility were associated with different effects of CFT treatment, while pain intensity, self-efficacy and catastrophising were not. Patients who had higher baseline activity limitation had greater treatment effects at 13 and 52 weeks. A person with a baseline RMDQ score of 18 (90th percentile) would on average be 6.1 (95% CI 4.8 to 7.4) points better at 13 weeks if they received CFT compared with usual care. However, a person with a baseline score of 7 (10th percentile) would on average be 3.6 (95% CI 2.6 to 4.6) points better at 13 weeks.</div></div><div><h3>Conclusion</h3><div>The finding that CFT is most effective among patients who are most disabled and incur the greatest burden strongly suggests that CFT should be considered as a treatment for this group of patients.</div></div><div><h3>Registration</h3><div>ACTRN12618001396213.</div></div>","PeriodicalId":49153,"journal":{"name":"Journal of Physiotherapy","volume":"70 4","pages":"Pages 294-301"},"PeriodicalIF":9.7000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Patients with worse disability respond best to cognitive functional therapy for chronic low back pain: a pre-planned secondary analysis of a randomised trial\",\"authors\":\"Mark Hancock , Anne Smith , Peter O’Sullivan , Robert Schütze , JP Caneiro , Jan Hartvigsen , Kieran O’Sullivan , Alison McGregor , Terry Haines , Alistair Vickery , Amity Campbell , Peter Kent\",\"doi\":\"10.1016/j.jphys.2024.08.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Question</h3><div>Do five baseline moderators identify patients with chronic low back pain who respond best to cognitive functional therapy (CFT) when compared with usual care?</div></div><div><h3>Design</h3><div>Secondary analysis of the RESTORE randomised controlled trial.</div></div><div><h3>Participants</h3><div>A total of 492 adults with low back pain for > 3 months with at least moderate pain-related activity limitation.</div></div><div><h3>Intervention</h3><div>Participants were allocated to CFT alone or CFT plus biofeedback; these two groups were combined for this secondary analysis. The control group was usual care.</div></div><div><h3>Outcome measures</h3><div>The outcome was activity limitation measured using the Roland Morris Disability Questionnaire (RMDQ) at 3, 6, 13, 26, 40 and 52 weeks. Investigated effect modifiers were baseline measures of activity limitation, cognitive flexibility, pain intensity, self-efficacy and catastrophising.</div></div><div><h3>Results</h3><div>Baseline levels of activity limitation and, potentially, cognitive flexibility were associated with different effects of CFT treatment, while pain intensity, self-efficacy and catastrophising were not. Patients who had higher baseline activity limitation had greater treatment effects at 13 and 52 weeks. A person with a baseline RMDQ score of 18 (90th percentile) would on average be 6.1 (95% CI 4.8 to 7.4) points better at 13 weeks if they received CFT compared with usual care. However, a person with a baseline score of 7 (10th percentile) would on average be 3.6 (95% CI 2.6 to 4.6) points better at 13 weeks.</div></div><div><h3>Conclusion</h3><div>The finding that CFT is most effective among patients who are most disabled and incur the greatest burden strongly suggests that CFT should be considered as a treatment for this group of patients.</div></div><div><h3>Registration</h3><div>ACTRN12618001396213.</div></div>\",\"PeriodicalId\":49153,\"journal\":{\"name\":\"Journal of Physiotherapy\",\"volume\":\"70 4\",\"pages\":\"Pages 294-301\"},\"PeriodicalIF\":9.7000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Physiotherapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S183695532400081X\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Physiotherapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S183695532400081X","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Patients with worse disability respond best to cognitive functional therapy for chronic low back pain: a pre-planned secondary analysis of a randomised trial
Question
Do five baseline moderators identify patients with chronic low back pain who respond best to cognitive functional therapy (CFT) when compared with usual care?
Design
Secondary analysis of the RESTORE randomised controlled trial.
Participants
A total of 492 adults with low back pain for > 3 months with at least moderate pain-related activity limitation.
Intervention
Participants were allocated to CFT alone or CFT plus biofeedback; these two groups were combined for this secondary analysis. The control group was usual care.
Outcome measures
The outcome was activity limitation measured using the Roland Morris Disability Questionnaire (RMDQ) at 3, 6, 13, 26, 40 and 52 weeks. Investigated effect modifiers were baseline measures of activity limitation, cognitive flexibility, pain intensity, self-efficacy and catastrophising.
Results
Baseline levels of activity limitation and, potentially, cognitive flexibility were associated with different effects of CFT treatment, while pain intensity, self-efficacy and catastrophising were not. Patients who had higher baseline activity limitation had greater treatment effects at 13 and 52 weeks. A person with a baseline RMDQ score of 18 (90th percentile) would on average be 6.1 (95% CI 4.8 to 7.4) points better at 13 weeks if they received CFT compared with usual care. However, a person with a baseline score of 7 (10th percentile) would on average be 3.6 (95% CI 2.6 to 4.6) points better at 13 weeks.
Conclusion
The finding that CFT is most effective among patients who are most disabled and incur the greatest burden strongly suggests that CFT should be considered as a treatment for this group of patients.
期刊介绍：
The Journal of Physiotherapy is the official journal of the Australian Physiotherapy Association. It aims to publish high-quality research with a significant impact on global physiotherapy practice. The journal's vision is to lead the field in supporting clinicians to access, understand, and implement research evidence that will enhance person-centred care. In January 2008, the Journal of Physiotherapy became the first physiotherapy journal to adhere to the ICMJE requirement of registering randomized trials with a recognized Trial Registry. The journal prioritizes systematic reviews, clinical trials, economic analyses, experimental studies, qualitative studies, epidemiological studies, and observational studies. In January 2014, it also became the first core physiotherapy/physical therapy journal to provide free access to editorials and peer-reviewed original research. The Australian Physiotherapy Association extended their support for excellence in physiotherapy practice by sponsoring open access publication of all Journal of Physiotherapy content in 2016. As a result, all past, present, and future journal articles are freely accessible, and there are no author fees for publication.
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