Early management of psychological factors for subjects with sub-acute low back pain.

ISRCTN ISRCTN55789697
DOI https://doi.org/10.1186/ISRCTN55789697
Secondary identifying numbers 21/2011
Submission date
24/02/2019
Registration date
26/06/2019
Last edited
10/06/2020
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Musculoskeletal Diseases
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

Background and study aims
It is increasingly recognised that psychological factors such as maladaptive beliefs, fear of movement and catastrophising play an important role in the transition from acute to chronic pain and the development of disability of subjects suffering from back complains Maladaptive coping and behaviour strategies are also found to be risk factors of persistent back complaints. Recently, a Cochrane review found that multidisciplinary bio-psychosocial rehabilitation induces pain reduction, disability improvement, favours return-to-work and fewer sick leave days when compared to usual care. However, current research yielded studies with low to very low-quality evidence, and poor effect sizes in terms of clinical meaningfulness. Therefore, additional high-quality trials were recommended before this approach can be implemented in clinical practice. Therefore, we decided to undertake this trial.

Who can participate?
Adults, both males and females.

What does the study involve?
A multidisciplinary rehabilitative programme incorporating psychological interventions based on patient-reported questionnaires targeted at the detection of main maladaptive thoughts and behaviours in comparison to general physiotherapy alone in the treatment of subacute LBP.

What are the possible benefits and risks of participating?
Clinically significant improvements in disability, pain, and quality of life. No side effects are expected.

Where is the study run from?
Scientific Institute of Lissone, Via Monsignor Bernasconi, 16, Lissone, Italy

When is the study starting and how long is it expected to run for?
January 2013 to December 2014

Who is funding the study?
Dept. Medical Science and Public Health - Faculty of Medicine, University of Cagliari, Italy

Who is the main contact?
Dr. Marco Monticone, marco.monticone@unica.it

Contact information

Prof Marco Monticone
Scientific

Dept. Medical Sciences and Public Health - Faculty of Medicine - Cittadella Universitaria
S.S. 554
Bivio Monserrato
Sestu
Cagliari
09042
Italy

ORCiD logoORCID ID 0000-0002-6526-888X
Phone +39 0706753109
Email marco.monticone@unica.it

Study information

Study designRandomized parallel-group superiority-controlled trial.
Primary study designInterventional
Secondary study designRandomised parallel trial
Study setting(s)Hospital
Study typeTreatment
Participant information sheet Not available in web format, please use contact details to request a participant information sheet.
Scientific titleEarly management of psychological factors reduce disability of subjects with sub-acute low back pain. Results of a randomized controlled study with one year follow-up.
Study objectivesA 10-week program based on early management of psychological factors integrated to task-oriented exercises would induce clinically significant improvements in disability, pain, and quality of life in subjects with subacute LBP vs. usual care, and that these would be maintained at least one year.
Ethics approval(s)Approved 18/12/2011, Ethical Committee Salvatore Maugeri Foundation (Via Monsignor Ennio Bernasconi, 16, 20851 Lissone MB, Italy; +39 039 46571; marco.monticone@fsm.it), ref: 21
Health condition(s) or problem(s) studiedSubacute low back pain
InterventionExperimental group. Task-oriented exercises and cognitive-behavioural therapy aimed at modifying wrong beliefs and behaviours concerning subacute pain.
Control group. exercises for passive spinal mobilisation, strengthening, muscle segmentary stretching, and postural control.

Randomization: the biostatistician randomized the subject to one of the two treatment programmes using a permuted-block randomization procedure. The list of treatment codes was previously generated and stored in Matlab and an automatic assignment system, also developed in Matlab, was used to conceal the allocation.

Treatment took place at the outpatient rehabilitative gym at the hospital, delivered by two physiatrists, a psychologist, and two equally-experienced physiotherapists.

During the treatment period, the questionnaires were administered by secretarial staff who checked them and returned any uncompleted part to the subjects for completion. At follow-up, the subjects were contacted personally by the same secretarial staff in order to ensure that the questionnaires were properly completed.
Intervention typeBehavioural
Primary outcome measureDisability assessed using the validated Italian version of the self-reported 10-item Oswestry Disability Questionnaire (ODI) before interventions, 10 weeks later (post-training), and 12 months (12M follow-up) after the end of treatment
Secondary outcome measuresBefore interventions, 10 weeks later (post-training), and 12 months (12M follow-up) after the end of treatment
1. Pain intensity assessed using an 11-point numerical rating scale
2. Kinesiophobia assessed using the validated Italian 13-item version of the self-report Tampa Scale for Kinesiophobia (TSK)
3. Unhelpful beliefs assessed by the 16-item questionnaire Pain Beliefs and Perceptions Inventory (PBAPI)
4. Anxiety and depression investigated by the Hospital Anxiety and Depression Score (HADS)
5. Strategies for coping pain were evaluated by the Coping Strategies Questionnaire-revised (CSQ-R)
6. Quality of Life assessed using the Italian version of the self-report Short-Form Health Survey (SF-36)
7. Return to work
8. Sick leave days
9. Patient-rated efficacy of treatment using the Global Perceived Effect scale (GPE)
Overall study start date30/11/2011
Completion date31/12/2015

Eligibility

Participant type(s)Patient
Age groupAdult
Lower age limit18 Years
SexBoth
Target number of participants135
Total final enrolment150
Key inclusion criteria1. Sub-acute (i.e., a documented history of pain lasting from 4 weeks to up to 12 weeks) non-specific low back pain attending our rehabilitation hospital
2. Good understanding of Italian
3. Age < 18 years
Key exclusion criteria1. Acute (lasting up to 4 weeks) and chronic LBP (lasting > twelve weeks)
2. Cognitive impairment (MMSE<24)
3. All causes of specific LBP, such as previous spinal surgery, deformity, infection, fracture or malignancy, unstable cardiovascular and pulmonary diseases, and systemic or neuromuscular diseases, ruled out by means of case histories and imaging
4. Previously received cognitive-behavioural therapy
Date of first enrolment01/01/2013
Date of final enrolment31/12/2014

Locations

Countries of recruitment

  • Italy

Study participating centre

Scientific Institute of Lissone
Via Monsignor Bernasconi, 16
Lissone (Monza Brianza)
20851
Italy

Sponsor information

Dept. Medical Science and Public Health - Faculty of Medicine
University/education

Cittadella Universitaria
S.S. 554
Bivio Monserrato
Sestu
Cagliari
09042
Italy

Phone +39.0706753120
Email mloi@amm.unica.it
Website https://www.unica.it/unica/it/dip_scienzemedsanpub.page
ROR logo "ROR" https://ror.org/003109y17

Funders

Funder type

University/education

Università degli Studi di Cagliari
Government organisation / Universities (academic only)
Alternative name(s)
Università degli Studi di Cagliari, Università di Cagliari, UNICA
Location
Italy

Results and Publications

Intention to publish date31/12/2019
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planPeer-reviewed journal with special interest to spinal disorders.
IPD sharing planThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request

Editorial Notes

10/06/2020: The total final enrolment was added.
11/03/2019: Trial’s existence confirmed by IRB