title: Testing the credibility, feasibility and acceptability of an optimised behavioural intervention (OBI) for avoidant chronic low back pain patients: protocol for a randomised feasibility study.
abstract: BACKGROUND
  Chronic back pain continues to be a costly and prevalent condition. The latest NICE guidelines issued in 2009 state that for patients with persistent back pain (of between six weeks and twelve months duration), who are highly distressed and/or disabled and for whom exercise, manual therapy and acupuncture has not been beneficial, the evidence supports a combination of around 100 hours of combined physical and psychological treatment. This is costly, and may prove unacceptable to many patients. A key recommendation of these guidelines was for further randomised controlled trials (RCTs) of psychological treatment and to target treatment to specific sub-groups of patients. Recent trials that have included psychological interventions have shown only moderate improvement at best, and results are not maintained long term. There is therefore a need to test theoretically driven interventions that focus on specific high-risk sub-groups, in which the intervention is delivered at full integrity against a credible control.
  
  
  METHODS
  A feasibility study of a pragmatic randomised controlled trial comparing psychologist-delivered Contextual Cognitive Behavioural Therapy (CCBT) against Treatment As Usual (TAU) physiotherapy delivered by physiotherapists for the treatment of chronic lower back pain in 'avoidant' patients. Ninety-two patients referred for physiotherapy will be recruited and randomised on a 1:1 basis to receive CCBT or TAU. Treatment groups will be balanced by centre and pain interference score. Primary outcomes include assessing the credibility and acceptability of the intervention, and to demonstrate proof of principle through a greater change in pain acceptance in the CCBT arm, measured by the Acceptance and Action -II and the Chronic Pain Acceptance questionnaires. In addition, the feasibility of carrying out a full trial will be explored with reference to recruitment and follow-up rates including the assessment of the burden of outcome measure completion. Secondary patient outcomes include disability, pain, fear of movement, mood, quality of life, and global recovery. Outcomes are measured at three and six months post-randomisation.
  
  
  CONCLUSIONS
  This paper details the rationale, design, therapist training system and recruitment methods to be used in a feasibility study which will inform the design and efficient implementation of a future definitive RCT.
  
  
  BACKGROUND
  ISRCTN43733490.
authors.affiliation: Department of Psychology, University of London, Royal Holloway, Egham, Surrey TW20 0EX, UK. t.pincus@rhul.ac.uk
authors.forename: Tamar
authors.initials: T
authors.lastname: Pincus
authors.forename: Shamaila
authors.initials: S
authors.lastname: Anwar
authors.forename: Lance
authors.initials: L
authors.lastname: McCracken
authors.forename: Alison
authors.initials: A
authors.lastname: McGregor
authors.forename: Liz
authors.initials: L
authors.lastname: Graham
authors.forename: Michelle
authors.initials: M
authors.lastname: Collinson
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Farrin
mesh_terms: D000339:Affect; D001362:Avoidance Learning; D059350:Chronic Pain / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D002985:Clinical Protocols; D015928:Cognitive Behavioral Therapy; D004185:Disability Evaluation; D004739:England; D005239:Fear; D005240:Feasibility Studies; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011788:Quality of Life; D012107:Research Design; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome