Lamb, S. E. (Sallie E.), Hansen, Zara, Lall, Ranjit, Castelnuova, Emanuela, Withers, Emma, Nichols, Vivien and Potter, Rachel (2010) Kognitive Gruppen-Verhaltenstherapie in der primären Gesundheitsversorgung bei LWS-Syndrom : eine randomisierte, kontrollierte Studie und Analyse der Kostenwirksamkeit. Osteopathische Medizin, Zeitschrift für ganzheitliche Heilverfahren, 11 (2). pp. 24-26. doi:10.1016/j.ostmed.2010.04.010 ISSN 1615-9071.

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Abstract

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 computergenerated 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, and the probability of cost-effectiveness was greater than 90% at a threshold of 3000 per QALY. There were no serious adverse events attributable to either treatment. Interpretation: Over one 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.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title:	Osteopathische Medizin, Zeitschrift für ganzheitliche Heilverfahren
Publisher:	Elsevier
ISSN:	1615-9071
Official Date:	2 June 2010
Dates:	Date Event 2 June 2010 Accepted
Volume:	11
Number:	2
Page Range:	pp. 24-26
DOI:	10.1016/j.ostmed.2010.04.010
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access

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