Preventing Chronic Disability: A Subacute Cognitive-Behavioural Disability Management Program for Occupational Injuries of the Lower Back
| Principal investigator(s): | Dean Tripp
(Queen's University) |
| Co-investigator(s): | Joan Stevenson, Matthew Faris, Wilma Hopman (Queen's University);
Anne Symes, Nomusa Mngoma (Providence Continuing Care Centre) |
| Sponsoring Institution: | Queen’s University |
Objective
The goal of this study was to examine the impact of a physiotherapist delivered cognitive/behavioral disability management program (CBDMP) for subacute low back injured workers targeting psychosocial risk factors of chronic pain (i.e., fear of reinjury, catastrophizing, perceptions of disability, depressed mood).
Method
This study used a randomized controlled parallel design with a treatment group and a "time matched" control. The initial sample consisted of 81 subacute low back injured workers (men= 38; women=43; mean age=39, SD=9.5). The randomization schedule placed 44 of these participants in the treatment group and 37 in the control. In the treatment group 21/44 (48%) participants finished the CBDMP providing complete data while 12/37 (33%) did so in the control. Contrasts of baseline data found no significant differences between those who completed the CBDMP and those who did not. Further, differences on these measures by the total number of sessions completed (e.g., 1-5) was not significant and those who had completed by group were no different on all baseline measures. Based on these results, subsequent analyses used completers only.
Results
Regressions showed that baseline pain (beta=.52, p.<.001) and fear avoidance beliefs (beta=.24, p.=.01) best predicted baseline disability and that catastrophizing (beta=.28, p.=.05) and fear avoidance beliefs (beta=.33, p.=.03) best predicted baseline pain report. Comparing across time and treatment group, catastrophizing was reduced with a two-fold change in noted in the treatment group (p.<.001; treatment scores dropping 60%; control 31%). Pain was equally reduced in both groups (p=.001; treatment 60%; control 55%). Disability was equally reduced across group (p.<.001; treatment 53%; control 54%). Fear of reinjury reduction showed a three-fold change in the treatment group (p=.003; treatment 27%; control 10%). Depressed mood dropped (p=.001) with a two-fold change in the treatment group (treatment 56%; control 22%). Fear Avoidance Beliefs were significantly reduced over time (p.<.001) but not differentially across groups (treatment 76%; control 73%). RTW logistic regressions indicate that baseline pain and changes in disability over the course of therapy were significantly associated with return to work following completion of the study treatment phase for both groups.
Conclusions
Differences were noted in risk factor reduction over the course of the physiotherapist delivered 5-week CBDMP. Greatest changes were shown for fear of reinjury, catastrophizing, and depressed mood, suggesting that cognitive behavioral interventions can reduce risk factors during the subacute phase of a low back injury for workers. These findings have practical treatment implications for reducing psychosocial risk factors during rehabilitation suggesting that CBDMP training by physiotherapists may lead to better risk profiles during the subacute phase of low back injury. Further data is required to examine long-term outcomes of a CBDMP intervention.
For more information: Dean.Tripp@queensu.ca
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