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Edorium Journal of

Disability and Rehabilitation

 
     
Review Article
 
Comparative effectiveness of cognitive behavioural therapy combined with exercise versus exercise in the management of non-specific chronic low back pain: A systematic review with meta-analysis
Paapa Kwesi Ampiah1, Paul Hendrick2, Erika Gonzalez Macias3
1Senior physiotherapist, Department of Physiotherapy, Ga South Municipal Hospital, Ghana Health Service, P. O. BOX 361 Mallam, Accra, Ghana
2Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, the University of Nottingham B90, Clinical Sciences Building, City Hospital Campus, Nottingham NG5 1PB, UK
3Central Hospital Dr. Ignacio Morones Prieto, Zona Universitaria, 78290, San Luis Potosi, Mexico

Article ID: 100041D05PA2018
doi: 10.5348/100041D05PA2018RA

Corresponding Author:
Paapa Kwesi Ampiah,
Head of Department,
Senior Physiotherapist,
Department of Physiotherapy,
Ga South Municipal Hospital,
Ghana Health Service,
P. O. Box 361 Mallam, Accra, Ghana

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How to cite this article
Ampiah PK, Hendrick P, Macias EG. Comparative effectiveness of cognitive behavioural therapy combined with exercise versus exercise in the management of non-specific chronic low back pain: A systematic review with meta-analysis. Edorium J Disabil Rehabil 2018;4:100041D05PA2018.


ABSTRACT

Aims: To systematically review the evidence for the effectiveness of combining cognitive behavioural therapy (CBT) and exercise versus exercise alone in the management of patients with non-specific chronic low back pain (NSCLBP).

Methods: Electronic search of CINAHL, PUBMED, Sports Discuss, SCOPUS, AMED, MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE, between 1990 – July 2017; complemented by hand searching of citation lists and citation tracking. Two independent reviewers screened titles and abstracts from the retrieved search results. Studies were considered based on PRISMA guidelines. Data was extracted based on Cochrane the Handbook of Systematic Reviews guidelines; the Cochrane Data Collection Form for Intervention Reviews (RCTs only), was customized and utilized. Risk of bias assessment was undertaken utilizing the Cochrane Back Review Group recommendations employing two independent reviewers. Meta-analysis was used to produce a weighted average for primary outcome measures, namely pain and disability. Results: Four studies were included (n = 406 participants); all studies provided post intervention results on pain and disability. Meta-analysis showed no significant difference between groups for both pain and disability, post intervention in the short term (pain; SMD -0.02, 95% CI -0.23 to 0.19; disability; SMD 0.06, 95% CI -0.15 to 0.27); medium term (pain; SMD -0.01, 95% CI -0.24 to0.22; disability; SMD 0.00, 95% CI -0.23 to 0.23); and long term (pain; SMD 0.06, 95% CI -0.18 to 0.29; disability; SMD -0.06, 95% CI -0.39 to 0.27).

Conclusion: The findings from this review reveal that there is no significant difference between groups; that is, there is moderate level evidence that the addition of CBT to exercise for patients with NSCLBP does not improve pain and disability outcomes in either the short, medium, or long term; however, both interventions (CBT plus exercise and exercise alone) produce favourable outcomes.

Keywords: Behavioural therapy, Chronic low back pain, Exercise therapy, Meta-analysis, Systematic review


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Author Contributions
Paapa Kwesi Ampiah – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Paul Hendrick – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Erika Gonzalez Macias – Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Conflict of Interest
Author declares no conflict of interest.
Copyright
© 2018 Paapa Kwesi Ampiah et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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