Can chronic disability be prevented? A randomized trial of a cognitive-behavior intervention and two forms of information for patients with spinal pain

Study Design, A randomized controlled design super imposed on treatment as usual was used to compare the effects of a cognitive-behavior intervention aimed at preventing chronicity with two different forms of information. Objective. To develop a coping-oriented preventive intervention applicable in primary care, and to compare its impact with educational information. Summary of Background Data. Preventing long-term disability resulting from spinal pain has proved difficult. The information provided by health care p rofessions and early interventions aimed at preventing long-term disability may be important, but little scientific evidence exists concerning their r ise. Methods, A protocol for a six-session cognitive-behavior group intervention was developed on the basis of earlier research. The main focus was to prev ent long-term disability by changing patients' behaviors and beliefs so the y can cope better with their problems. Comparison groups received either a pamphlet shown earlier to have an effect, or a more extensive information p ackage consisting of six installments. All the groups continued to receive treatment as usual in primary care. There were 243 patients with acute or s ubacute spinal pain who perceived that they were at risk for developing a c hronic problem. These patients were randomized to the cognitive-behavioral intervention or one of the two information groups, Because the aim was to p revent long-term disability, the key outcome variables at the 1-year follow -up assessment were sick absenteeism and health care use. Other variables w ere pain, Function, fear-avoidance beliefs, and cognitions. Results. The comparison groups reported benefits. However, the risk for a l ong-term sick absence developing was lowered ninefold for the cognitive-beh avior intervention group as compared with the risk for the information grou ps (relative risk, 9.3). Participants in the cognitive behavior group also reported a significant decrease in perceived risk. In addition, the cogniti ve-behavior group demonstrated a significant decrease in physician and phys ical therapy use as compared with two groups receiving information, in whic h such use increased. All three groups tended to improve on the variables o f pain, fear-avoidance, and cognitions. Conclusions. This study demonstrates that a cognitive-behavior group interv ention can lower the risk of a long-term disability developing. These findi ngs under score the significance of early interventions that specifically a im to prevent chronic problems. This approach might be applied to primary c are settings.