Document Detail


Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis.
MedLine Citation:
PMID:  20189241     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Low-back pain is a common and costly problem. We estimated the effectiveness of a group cognitive behavioural intervention in addition to best practice advice in people with low-back pain in primary care.
METHODS: In this pragmatic, multicentre, randomised controlled trial with parallel cost-effectiveness analysis undertaken in England, 701 adults with troublesome subacute or chronic low-back pain were recruited from 56 general practices and received an active management advisory consultation. Participants were randomly assigned by computer-generated block randomisation to receive an additional assessment and up to six sessions of a group cognitive behavioural intervention (n=468) or no further intervention (control; n=233). Primary outcomes were the change from baseline in Roland Morris disability questionnaire and modified Von Korff scores at 12 months. Assessment of outcomes was blinded and followed the intention-to-treat principle, including all randomised participants who provided follow-up data. This study is registered, number ISRCTN54717854.
FINDINGS: 399 (85%) participants in the cognitive behavioural intervention group and 199 (85%) participants in the control group were included in the primary analysis at 12 months. The most frequent reason for participant withdrawal was unwillingness to complete questionnaires. At 12 months, mean change from baseline in the Roland Morris questionnaire score was 1.1 points (95% CI 0.39-1.72) in the control group and 2.4 points (1.89-2.84) in the cognitive behavioural intervention group (difference between groups 1.3 points, 0.56-2.06; p=0.0008). The modified Von Korff disability score changed by 5.4% (1.99-8.90) and 13.8% (11.39-16.28), respectively (difference between groups 8.4%, 4.47-12.32; p<0.0001). The modified Von Korff pain score changed by 6.4% (3.14-9.66) and 13.4% (10.77-15.96), respectively (difference between groups 7.0%, 3.12-10.81; p<0.0001). The additional quality-adjusted life-year (QALY) gained from cognitive behavioural intervention was 0.099; the incremental cost per QALY was 1786 pound sterling, and the probability of cost-effectiveness was greater than 90% at a threshold of 3000 pound sterling per QALY. There were no serious adverse events attributable to either treatment.
INTERPRETATION: Over 1 year, the cognitive behavioural intervention had a sustained effect on troublesome subacute and chronic low-back pain at a low cost to the health-care provider.
FUNDING: National Institute for Health Research Health Technology Assessment Programme.
Authors:
Sarah E Lamb; Zara Hansen; Ranjit Lall; Emanuela Castelnuovo; Emma J Withers; Vivien Nichols; Rachel Potter; Martin R Underwood;
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-02-25
Journal Detail:
Title:  Lancet     Volume:  375     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-15     Completed Date:  2010-03-30     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  916-23     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Ltd. All rights reserved.
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN54717854
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Chronic Disease
Cognitive Therapy* / economics
Cost-Benefit Analysis
Female
Great Britain
Humans
Low Back Pain / economics,  therapy*
Male
Middle Aged
Primary Health Care* / economics
Psychotherapy, Group* / economics
Treatment Outcome
Young Adult
Grant Support
ID/Acronym/Agency:
01/75/01//Department of Health
Investigator
Investigator/Affiliation:
S E Lamb / ; M R Underwood / ; Z Hansen / ; L Pengel / ; G Foster / ; E J Withers / ; M Vickers / ; L Letley / ; A Chauhan / ; S Carpenter / ; R Potter / ; R Lall / ; A Daykin / ; L Craven / ; S Page / ; E Castelnuovo / ; A Szczpura / ; M Clark / ; J Briant / ; V Brueton / ; J Coult / ; A Dearden / ; J Edwards / ; A Hall / ; L Hand / ; K Holt / ; K Horsler / ; C Jarvey / ; S Jepson / ; A Law / ; J Lowe / ; P Marsh / ; D Medlock / ; J A Miles / ; O Neeley / ; V Nichols / ; T O'Brien / ; M Ogden / ; G Pearn / ; E Rayfield / ; S Rowland / ; J Rushmer / ; N Sloan / ; B Stewart / ; S Thompson / ; R Turnbull / ; G Walker / ; S Webb / ; A Williams / ; M Woolvine / ; S Stewart-Brown / ; C Sackley / ; R Jones / ; C McCarthy / ; S Joseph / ; R Hills / ; G MacFarlane / ; P Watson /
Comments/Corrections
Comment In:
Evid Based Med. 2010 Aug;15(4):118-9   [PMID:  20530609 ]
Lancet. 2010 Mar 13;375(9718):869-70   [PMID:  20189240 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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