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Comparative effectiveness of conservative interventions for nonspecific chronic spinal pain: physical, behavioral/psychologically informed, or combined? A systematic review and meta-analysis

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dc.contributor.author O'Keeffe, Mary
dc.contributor.author Purtill, Helen
dc.contributor.author Kennedy, Norelee
dc.contributor.author Conneely, Mairead
dc.contributor.author Hurley, John
dc.contributor.author O'Sullivan, Peter B.
dc.contributor.author Dankaerts, Wim
dc.contributor.author O'Sullivan, Kieran
dc.date.accessioned 2017-09-21T10:34:34Z
dc.date.available 2017-09-21T10:34:34Z
dc.date.issued 2016
dc.identifier.uri http://hdl.handle.net/10344/6093
dc.description peer-reviewed en_US
dc.description.abstract Nonspecific chronic spinal pain (NSCSP) is highly disabling. Current conservative rehabilitation commonly includes physical and behavioral interventions, or a combination of these approaches. Physical interventions aim to enhance physical capacity by using methods such as exercise, manual therapy, and ergonomics. Behavioral/psychologically informed interventions aim to enhance behaviors, cognitions, or mood by using methods such as relaxation and cognitive behavioral therapy. Combined interventions aim to target physical and also behavioral/psychological factors contributing to patients' pain by using methods such as multidisciplinary pain management programs. Because it remains unclear whether any of these approaches are superior, this review aimed to assess the comparative effectiveness of physical, behavioral/psychologically informed, and combined interventions on pain and disability in patients with NSCSP. Ten electronic databases were searched for randomized controlled trials (RCTs) including participants reporting NSCSP. Studies were required to have an "active" conservative treatment control group for comparison. Studies were not eligible if the interventions were from the same domain (eg, if the study compared 2 physical interventions). Study quality was assessed used the Cochrane Back Review Group risk of bias criteria. The treatment effects of physical, behavioral/psychologically informed, and combined interventions were assessed using meta-analyses. Twenty-four studies were included. No clinically significant differences were found for pain and disability between physical, behavioral/psychologically informed, and combined interventions. The simple categorization of interventions into physical, behavioral/psychologically informed, and combined could be considered a limitation of this review, because these interventions may not be easily differentiated to allow accurate comparisons to be made. Further work should consider investigating whether tailoring rehabilitation to individual patients and their perceived risk of chronicity, as seen in recent RCTs for low back pain, can enhance outcomes in NSCSP.Perspective: In this systematic review of RCTs in NSCSP, only small differences in pain or disability were observed between physical, behavioral/psychologically informed, and combined interventions. (C) 2016 by the American Pain Society. en_US
dc.language.iso eng en_US
dc.publisher Elsevier en_US
dc.relation.ispartofseries Journal of Pain;17 (7), pp. 755-774
dc.rights This is the author’s version of a work that was accepted for publication in The Journal of Pain. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in The Journal of Pain, 17 (7), pp. 755-774, http://dx.doi.org/10.1016/j.jpain.2016.01.473 en_US
dc.subject physical en_US
dc.subject behavioral/psychological en_US
dc.subject combined en_US
dc.subject systematic review en_US
dc.subject nonspecific chronic spinal pain en_US
dc.title Comparative effectiveness of conservative interventions for nonspecific chronic spinal pain: physical, behavioral/psychologically informed, or combined? A systematic review and meta-analysis en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.date.updated 2017-09-21T10:21:08Z
dc.description.version ACCEPTED
dc.identifier.doi 10.1016/j.jpain.2016.01.473
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US
dc.internal.rssid 1646047
dc.internal.copyrightchecked Yes
dc.identifier.journaltitle The journal of pain : official journal of the American Pain Society
dc.description.status peer-reviewed


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