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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
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Official URL: http://dx.doi.org/10.1186/1471-2474-15-17
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 | ||||
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| Subjects: | B Philosophy. Psychology. Religion > BF Psychology R Medicine > R Medicine (General) |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| 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: |
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| 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 | ||||
| Funder: | National Institute for Health Research (Great Britain) (NIHR), Collaborations for Leadership in Applied Health Research and Care (CLAHRC) |
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