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Treatment compliance and effectiveness of a cognitive behavioural intervention for low back pain : a complier average causal effect approach to the BeST data set

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Knox, Christopher R., Lall, Ranjit, Hansen, Zara and Lamb, S. E. (Sallie E.) (2014) Treatment compliance and effectiveness of a cognitive behavioural intervention for low back pain : a complier average causal effect approach to the BeST data set. BMC Musculoskeletal Disorders, Volume 15 . Article number 17. doi:10.1186/1471-2474-15-17 ISSN 1471-2474.

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Official URL: http://dx.doi.org/10.1186/1471-2474-15-17

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Abstract

Background:
Group cognitive behavioural intervention (CBI) is effective in reducing low-back pain and disability in comparison to advice in primary care. The aim of this analysis was to investigate the impact of compliance on estimates of treatment effect and to identify factors associated with compliance.

Methods:
In this multicentre trial, 701 adults with troublesome sub-acute or chronic low-back pain were recruited from 56 general practices. Participants were randomised to advice (control n = 233) or advice plus CBI (n = 468). Compliance was specified a priori as attending a minimum of three group sessions and the individual assessment. We estimated the complier average causal effect (CACE) of treatment.

Results:
Comparison of the CACE estimate of the mean treatment difference to the intention-to-treat (ITT) estimate at 12 months showed a greater benefit of CBI amongst participants compliant with treatment on the Roland Morris Questionnaire (CACE: 1.6 points, 95% CI 0.51 to 2.74; ITT: 1.3 points, 95% CI 0.55 to 2.07), the Modified Von Korff disability score (CACE: 12.1 points, 95% CI 6.07 to 18.17; ITT: 8.6 points, 95% CI 4.58 to 12.64) and the Modified von Korff pain score (CACE: 10.4 points, 95% CI 4.64 to 16.10; ITT: 7.0 points, 95% CI 3.26 to 10.74). People who were non-compliant were younger and had higher pain scores at randomisation.

Conclusions:
Treatment compliance is important in the effectiveness of group CBI. Younger people and those with more pain are at greater risk of non-compliance.

Item Type: Journal Article
Subjects: B Philosophy. Psychology. Religion > BF Psychology
R Medicine > R Medicine (General)
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Cognitive therapy, Backache, Chronic pain
Journal or Publication Title: BMC Musculoskeletal Disorders
Publisher: Biomed central
ISSN: 1471-2474
Official Date: 2014
Dates:
DateEvent
2014Published
Volume: Volume 15
Page Range: Article number 17
DOI: 10.1186/1471-2474-15-17
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access (Creative Commons)
Date of first compliant deposit: 26 December 2015
Date of first compliant Open Access: 26 December 2015
Funder: National Institute for Health Research (Great Britain) (NIHR), Collaborations for Leadership in Applied Health Research and Care (CLAHRC)

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