Patient education based on principles of cognitive behavioral therapy for a patient with persistent low back pain: a case report.
METHODS
Case report.


BACKGROUND
Cognitive behavioral therapy (CBT) is an effective intervention for patients with persistent pain. Recent research indicates that physical therapists self-perceive a lack of knowledge, skills, and time to provide this intervention. The purpose of this case report is to describe how specific CBT strategies can be integrated with multimodal physical therapist management of a patient with persistent low back pain.


METHODS
The patient was a 70-year-old female with activity limitations of walking, standing, and forward bending. Oswestry Disability Questionnaire score was 19/50 and Fear-Avoidance Belief Questionnaire physical activity subscale was 23/24. The Low Back Activity Confidence Scale revealed 19%, 100%, and 84% for function, symptom self-regulation, and exercise, respectively. CBT-based patient education was provided in combination with manual therapy and exercise. CBT techniques included cognitive restructuring, goal setting, activity pacing, problem-solving strategies, graded exposure, encouraging exposure to pleasant experiences, and maintenance strategies.


RESULTS
The patient was discharged after 7 visits distributed over 21 weeks. Her Oswestry Disability Questionnaire score was reduced 10% and Fear-Avoidance Belief Questionnaire physical activity subscale score reduced 48%. On the Low Back Activity Confidence Scale the patient's scores were 19%, 87%, and 94% for function, symptom self-regulation, and exercise, respectively.


CONCLUSIONS
This case report describes the use of CBT techniques during patient education by a physical therapist. The patient demonstrated clinically measurable and significant improvements in disability. Improvements in both self-efficacy beliefs related to exercise and activity avoidance beliefs were associated with improvement in disability. Additional research is needed to determine best practices for CBT-based patient education by physical therapists.


METHODS
Therapy, level 4.
Rundell
Sean D
SD
Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building F-262, Box 357236, Seattle, WA 98195-7236, USA. srundell@u.washington.edu
Davenport
Todd E
TE
D000368:Aged; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000628:therapy*; D008349:Manipulation, Orthopedic; D051346:Mobility Limitation; D010353:Patient Education as Topic; D020377:Self Efficacy