The effectiveness of cognitive-behavioural interventions with people ...

13AUTHOR& DATEPURPOSEDESIGN& SAMPLEOUTCOMES ANDINTERVENTIONRESULTSCONCLUSIONS &IMPLICATIONSCohen,Heinrich,Naliboff et al.(1983)- to compare 2outpatient grouptreatment methodsfor chronic lowback pain- before-after design,treatment-outcomestudy - comparing 2groups, no randomassignment, nocontrol group.- N=25 outpatientswith chronic lowback pain of at least6 months duration.- evaluations pre- andpost-treatment, nofollow-up.- 4 domains of painexperience evaluated:physical abilities, physicalfunctioning, psychologicaland psychosocialfunctioning, and painintensity and perception.- 2 group interventionscompared: physical therapytreatment and behaviourtherapy, which includedrelaxation, guided imagery,goal setting, activitymanagement, problemsolvingand assertivenesstraining.Each group 10 sessions.- significant improvementsfound in both treatmentgroups in terms of less pain,less activity limitations frompain, less psychologicaldistress, and satisfaction withtreatment.- PT group demonstratedimproved low back control,but not generalization todaily activities; plussignificant decrease inoverall depression scores.- behavioural groupdemonstrated a trend towardsincreasing social andphysical activities, but notstatist. significant.- Weak support found for thehypotheses that grouptreatment would have similaroutcomes in 4 domains ofpain experience; differentialeffects for each type oftreatment were minimal in thisstudy.- Methodological flawsweaken strength ofconclusions, in particular, nocontrol group, small samplesize.- Limited application to OTpractice due tomethodological weaknesses.Corey, Etlin &Miller (1987)- to evaluated acognitivebehaviouraltreatment programfor people withchronic pain,conducted in theirhomes- before-after design,program evaluation,no control group.- N=72 subjectsreferred to one clinic;variety of diagnoses.All had not workeddue to pain for amean of 28 months.- evaluationsconducted before andimmediately aftertreatment, and onefollow up, avg. 18months afterdischarge.- outcomes focused on workstatus,; pain reduction,functioning level andcoping ability were reportedsubjectively by subjectspost-treatment and onfollow-up.- cognitive-behaviouralprogramme includededucation about painmanagement, coping skills,stress mngmnt., exerciseand lifestyle restructuring,behavioural techniques,meds. reduction and sleepscheduling techniques. Inhomevisits avgd. 2x/weekinitially, to 1x/month, for 5mos.- 70% of subjects hadreturned to some form ofwork or re-trainingimmediately after treatmentand on follow-up.- subjective reports of painreduction indicated thatsubjects who returned tosome form of work reporteda mean percent of painreduction of 32 - 79%, aswell as a range of 27 - 77%increase in functioning and27 - 82% increase in copingability. In comparison, thosesubjects not workingreported a range of 2.5-11%pain reduction, 3-7%functioning increase, and 6-8% increase in coping.- Outcomes indicate positivebenefits of a cognitivebehaviouralprogramme forpeople with chronic pain.- Results are not conclusivedue to weak methodology, nocontrol group.- Self-report measures werefound to be highly associatedwith a more objective measureof functioning - work status.- sSrengths of programme areworthy of OT’s attention:home setting, involvement offamilies, individualizedtreatment and focus onactivity.