Efficacy of a Classification Based 'Cognitive Functional Therapy' in Nurses With Non Specific Chronic Low Back Pain
Condition: Chronic Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      A series of case-studies to explore the efficacy of classification based cognitive functional
      physiotherapy according to the classification system proposed by Peter O'Sullivan in specific
      nursing population with non specific chronic low back pain.

      The investigators hypothesis was that treatment targeting the mechanisms behind the problem
      from a multidimensional perspective would be effective to reduce pain, disability and
      sick-leave.
    

Detailed description: 
      Low back pain (LBP) is a common, recalcitrant and costly health problem, which limits
      patients' daily activities. In 85% of the cases, LBP is classified as 'non-specific', which
      means there is no clear underlying patho-anatomical/radiological abnormality. This subgroup
      often gives rise to a chronic fluctuating problem. Although most cases of LBP resolve within
      8 to 12 weeks, it may become chronic in up to 15% of patients. LBP constitutes an enormous
      and growing medical and socio-economical problem for the modern society. Nursing has been
      identified amongst the top professions at risk for occupational LBP, with lifetime prevalence
      between 66%-82%. The impact of LBP for nurses includes time off work, increased risk of
      chronicity, associated personal and economic costs and reduced nursing workforce efficiency.

      Non Specific Chronic Low Back Pain (NSCLBP) is widely viewed as a multifactorial
      biopsychosocial pain syndrome. It has been proposed by several authors that NSCLBP represents
      a vicious cycle associated with different combinations of maladaptive; cognitive (negative
      beliefs, fear avoidance behaviours, catastrophising, depression, stress, lack of pacing and
      coping), physical (pain provocative postures, movement patterns and pain behaviours) and
      lifestyle (inactivity, rest) behaviours that act to promote pain and disability. However a
      recent systematic review suggests that this change in paradigm and the investigators new
      understanding of NSCLBP has not resulted in clinical trials utilizing multidimensional
      classification systems or targeted interventions based on the underlying mechanisms. In line
      with this paradigm shift a novel multidimensional classification system has been developed
      incorporating the biopsychosocial model, which subgroups patients based on their underlying
      pain mechanism. Enabling a classification based interventions targetting the maladaptive
      cognitive, physical and lifestyle behaviours associated with the disorder.
    

Intervention name(s): Classification Based Cognitive Functional Therapy
Intervention type(s): Other
Intervention description(s): A novel multidimensional classification system has been developed incorporating the biopsychosocial model, which subgroups patients based on their presentation. This subclassification is the base for matched interventions directed at the maladaptive cognitive, physical and lifestyle behaviours associated with the disorder. The intervention is called 'cognitive functional therapy' as it directly challenges these behaviours in a functionally specific and graduated manner.
Other intervention name(s): cognitive functional therapy
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Pain; Back Pain; Low Back Pain; Chronic Low Back Pain; Cognitive Functional Therapy; Intervention; Subclassification; Multidimensional