title: Behavioural treatment for chronic low back pain.
abstract: BACKGROUND
  The treatment of chronic low back pain is not primarily focused on removing an underlying organic pathology, but at the reduction of disability through the modification of environmental contingencies and cognitive processes. Behavioural interventions are commonly used in the treatment of chronic (disabling) low back pain.
  
  
  OBJECTIVE
  The objective of this systematic review was to determine if behavioural therapy is more effective than reference treatments for chronic non-specific low back pain, and which type of behavioural treatment is most effective.
  
  
  METHODS
  We searched the Medline, PsycLit databases, and the Cochrane Controlled Trials Register up to April 1999, Embase up to September 1999. We also screened references of identified randomised trials and relevant systematic reviews.
  
  
  METHODS
  Only randomised trials on any type of behavioural treatment for non-specific chronic low back pain were included.
  
  
  METHODS
  Methodological quality assessment and data extraction was done by two reviewers independently. The magnitude of effect was assessed by computing a pooled effect size for each domain (i.e., behavioural outcomes, overall improvement, back pain specific and generic functional status, return to work, and pain intensity) using the random effects model.
  
  
  RESULTS
  Only 6 studies (25%) were high quality. There is strong evidence (level 1) that behavioural treatment has a moderate positive effect on pain intensity (pooled effect size 0.62; 95% CI 0.25, 0.98), and small positive effects on generic functional status (pooled effect size 0.35; 95% CI -0.04, 0.74) and behavioural outcomes (pooled effect size 0.40; 95% CI 0.10, 0.70) of chronic low back pain patients when compared to waiting list controls or no treatment. There is moderate evidence (level 2) that an additional behavioural component to a usual treatment program for chronic low back pain has no positive short-term effect on generic functional status (pooled effect size 0.31; 95% CI - 0.01, 0.64), pain intensity (pooled effect size 0.03; 95% CI - 0.30, 0. 36) and behavioural outcomes (pooled effect size 0.19; 95% CI - 0.08, 0.45).
  
  
  CONCLUSIONS
  Behavioural treatment seems to be an effective treatment for chronic low back pain patients, but it is still unknown what type of patients benefit most from what type of behavioural treatment.
authors.affiliation: Institute for Research in Extramural Medicine, Vrije Universiteit, van der Boechorststraat 7, Amsterdam, Netherlands, 1081 BT. mw.van_tulder.emgo@med.vu.nl
authors.forename: M W
authors.initials: MW
authors.lastname: van Tulder
authors.forename: R W
authors.initials: RW
authors.lastname: Ostelo
authors.forename: J W
authors.initials: JW
authors.lastname: Vlaeyen
authors.forename: S J
authors.initials: SJ
authors.lastname: Linton
authors.forename: S J
authors.initials: SJ
authors.lastname: Morley
authors.forename: W J
authors.initials: WJ
authors.lastname: Assendelft
mesh_terms: D001521:Behavior Therapy; D002908:Chronic Disease; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*