THE EFFECTIVENESS OF COGNITIVE BEHAVIORAL THERAPY (CBT) WITH GENERAL EXERCISES VERSUS GENERAL EXERCISES ALONE IN THE MANAGEMENT OF CHRONIC LOW BACK PAIN
Abstract: Background/Aims: To evaluate the effectiveness of Cognitive Behavioural Therapy (CBT) along with General exercises and General exercises alone in chronic low back pain. Back pain could arise from many sources that include vertebral joints and disk degeneration, sacroiliac joint, muscle tightness and weakness, neural structures, thoracolumbar fascia, stomach, kidneys and other abdominal organs. According to CBT theory, inappropriate cognitions and poor pain coping behaviors may interact with biological factors and social, environmental consequences. This interaction may produce unwanted outcomes, which includes higher pain intensity, pain-related disability, and utilization of health care resources.
Method: Total 54 patients with chronic low back pain who fulfilled inclusion criteria were recruited from Physiotherapy, Department of Alain Poly Clinic Karachi and Institute of Physical Medicine & Rehabilitation Dow University of Health Sciences Karachi. Selected patients were equally divided and randomly assigned into two groups with simple randomisation method. The Cognitive Behavioural Therapy (CBT) and General exercises group received Operant model of CBT and General Exercises whereas General exercises group received General exercises only. Both groups received a home exercise program as well. Patients in both groups received 3 treatment sessions per week for 12 consecutive weeks. Clinical assessment was performed using Visual Analogue Scale (VAS) and Ronald Morris Disability Questionnaire at baseline and after 12 weeks.
Results: Both study groups showed statistically significant improvements in both outcome measures p=0.000. However, mean improvements in post intervention VAS score and Ronald Morris score was better in CBT and exercises group as compared to General exercise group. In CBT and exercises group, mean VAS score reduced to 2.66±1.39 post interventions which was 6.51±1.34 on base line. Ronald Morris score also reduced to 5.33±2.67 post interventions, which was 13.77±2.53 on base line. In General exercise group mean VAS score reduced to 5.25±1.19 post interventions, which was 7.03±1.25 on base line. Ronald Morris score also reduced to 9.88±1.84 post interventions which was 12.92±2.09 on base line.
Conclusion: In conclusion, both interventions are effective in treating chronic low back pain however; CBT & General exercises are clinically more effective than General exercises alone.
Dr. Muhammad Khan ( Director Physio & Rehab LRH, Peshawar )