Exercise-based physiotherapy management of partients with persistent, non-specific low back pain : A cognitive-behavioural approach to assessment and treatment in a primary care setting

Abstract: The overall aim of this thesis was to develop, describe, and evaluate exercise-based physiotherapy management with a cognitive-behavioural approach in a primary care setting for individuals with subacute, recurrent, or chronic non-specific low back pain (LBP). A structured and integrated physiotherapy and cognitive-behavioural programme was developed and evaluated in controlled single-case studies.The Roland and Morris Disability Questionnaire was translated into Swedish and tried in a sample of 72 subjects. It was found to be a reliable and valid measure of disability in LBP patients. The integrated approach was evaluated in a randomised clinical trial where 36 subjects were given either the integrated programme (n = 18) or exercise therapy only (n = 18). The short term results show that both groups improved significantly in pain intensity, disability, life satisfaction, and functional self-efficacy. The groups differed in pain intensity, with lower scores in the experimental group. Subgroups among LBP patients were investigated in a sample of 89 subjects. Based on responses to The Multidimensional Pain Inventory (MPI), three subgroups were identified. These were labeled "Functional", "Dysfunctional", and "Adaptive copers" differed significantly in their report of initial disability. In a smaller sub-sample (n = 48) differences in life satisfaction and functional self-efficacy were also found. Further, the subgroups differed significantly in their response to the treatment. The main conclusions are that the integrated approach was as effective as exercise therapy only in the short term, and that subgrouping of subjects by the MPI revealed patterns of treatment responses that have implications for the clinical management of patients with persistent, non-specific LPB.

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