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

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22AUTHOR& DATEPURPOSEDESIGN& SAMPLEOUTCOMES ANDINTERVENTIONRESULTSCONCLUSIONS &IMPLICATIONSTurner (1982)- to evaluate theeffectiveness ofgroup progressiverelaxationvs.Cognitivebehavioural(C-B)group therapy forpeople withchronic low backpain.- RCT design,assignment to 1 of 3conditions:relaxation groupalone, relaxationwith C-B grouptherapy, or controlgroup.- measurements preandpost-treatment, 1month, and 2-yearmail follow-up.- N=34 outpatientswith chronic lowback pain, 6 monthsor more duration.- outcomes includedphysical and psychosocialdysfunction, meds. use,depression, pain severity,self-ratings of improvement.2 year mail follow-upfocused on work status,health services use, medsand pain severity.- 5 weekly sessions with 5-7patients per group: 1.progressive-relaxationalone; 2. relaxation with C-B strategies; 3. Wait-listcontrol with weekly phonecall.- both treatment groupsshowed statistic. significantimprovement in depression,physical and psych.functioning and pain rating.C-B group also improvedsignificantly on daily painratings & pain tolerance, andshowed continuedimprovement on all measuresat 1 mo. follow-up.- decreased health care use inboth groups at 2 year followup.- Evidence provided that bothtypes of treatment result inimprovement in physical andpsych. function, depressionand perception of pain.Cognitive-behaviouraltreatment demonstrates longtermbenefits for people withmild chronic low back pain.- Study supports use ofcognitive-behavioural andrelaxation therapy in anoutpatient group format,although sample size wassmall.Turner &Jensen (1993)- to study theeffects ofoutpatient groupcognitive therapy,relaxation trainingand combinedcognitive andrelaxation therapyfor people withchronic low backpain.- RCT design of 3treatment conditions(relaxation alone,cognitive alone,combined relaxationand cognitivetherapies) and 1control (wait-list)condition.- repeated measurespre-and posttreatment, 6- and 12-month follow-up.- N=102 outpatientswith low back painof more than 6months.- 4 main outcomes: painintensity, sickness impact(physical and psych.functioning), depression,cognitive errors; and 1process measure usingvideotapes of painbehaviours.- group treatments, weeklyfor 6 weeks, 5-10 patientsper group: 1. Relaxationtraining group;2. Cognitive therapy;3. Combinedcognitive/relaxationtraining. Control group onwait-list.- subjects in all 3 treatmentgroups improvedsignificantly in self-reportedpain intensity, and showeddecreases in cognitive errors.These improvements weremaintained at 6 and 12month follow-up. Otheroutcome measures did notshow any statisticallysignificant differences.- Results provide someevidence that cognitivetherapy and relaxationtraining are equally effectivein reducing pain.- Insufficient power in thisstudy may have resulted inlack of detection ofdifferences in other outcomes.- Results support grouptreatment format for OT’sworking with patients withchronic pain.
23AUTHOR& DATEPURPOSEDESIGN& SAMPLEOUTCOMES ANDINTERVENTIONRESULTSCONCLUSIONS &IMPLICATIONSTurner &Clancy (1988)- to evaluate andcompare operantbehaviouralandcognitivebehaviouralapproaches for thetreatment ofchronic low backpain.- RCT design,assignment to 1 of 2treatment groups or acontrol group.- repeated measurespre and posttreatmentand 6- and12-month follow-up.- N= 81 subjects withchronic low backpain, more than 6months duration.- outcome measuresincluded PainQuestionnaire, videotapesof pain behaviours, painbehaviour checklist,Sickness Impact Profile, andCognitive ErrorsQuestionnaire.- out-patient treatmentgroups run 1x/week for 8weeks: operant-behaviouralor cognitive-behaviouralapproaches. Control groupon wait-list.- stat. significantimprovements on SicknessImpact Profile, cognitiveerrors and pain behaviours inboth treatment groups.Improvement greater inoperant-behav.. groupimmediately post-treatment,but cognitive-behav. groupcontinued to improve at 6-and 12-month follow-up toeven out.Cognitive-behav. group weremore satisfied withtreatment.- Both types of behaviouraltreatment resulted in short andlong-term improvement inmultiple aspects of chronicpain - patterns ofimprovement varied withoperant-behav. treatmentshowing immediateimprovment and cognitivebehav.showing steadyimprovement over time.- Well-designed studysupports both types oftreatment for people with mildlow back pain.White &Nielson(1995)- follow-up studyto previousresearch on shorttermeffects of CBtreatment withpersons withfibromyalgia (seeNielson, Walker &McCain).- quasi-experimentaldesign, repeat ofearlier study with 25inpatients withfibromyalgia- follow-upevaluation at a meanof 30 months afterdischarge- same “target” and “nontarget”outcomes as firststudy. Target outcomes(variables which theprogram addressed)included pain severity,control, activity interferenceemotional/affective statusand observed painbehaviour.- same treatment program asprevious study.- 3/10 target variablesremained statisticallydifferent from pretreatment:worry, observed painbehaviour, and control overpain. All other targetvariables changed in thedirection of improvement,but were not statisticallysignificant.- non-target variables did notshow any significantdifference, as expected.- Improvements found atfollow-up support a cognitivebehaviouralapproach forpeople with fibromyalgia.- Limitations included smallsample size, no control group,cointervention of medicationuse. Results are notgeneralizable based on theselimitations, but show promise.
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