title: The Effectiveness of Cognitive Behavioural Treatment for Non-Specific Low Back Pain: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  To assess whether cognitive behavioural (CB) approaches improve disability, pain, quality of life and/or work disability for patients with low back pain (LBP) of any duration and of any age.
  
  
  METHODS
  Nine databases were searched for randomised controlled trials (RCTs) from inception to November 2014. Two independent reviewers rated trial quality and extracted trial data. Standardised mean differences (SMD) and 95% confidence intervals were calculated for individual trials. Pooled effect sizes were calculated using a random-effects model for two contrasts: CB versus no treatment (including wait-list and usual care (WL/UC)), and CB versus other guideline-based active treatment (GAT).
  
  
  RESULTS
  The review included 23 studies with a total of 3359 participants. Of these, the majority studied patients with persistent LBP (>6 weeks; n=20). At long term follow-up, the pooled SMD for the WL/UC comparison was -0.19 (-0.38, 0.01) for disability, and -0.23 (-0.43, -0.04) for pain, in favour of CB. For the GAT comparison, at long term the pooled SMD was -0.83 (-1.46, -0.19) for disability and -0.48 (-0.93, -0.04) for pain, in favour of CB. While trials varied considerably in methodological quality, and in intervention factors such as provider, mode of delivery, dose, duration, and pragmatism, there were several examples of lower intensity, low cost interventions that were effective.
  
  
  CONCLUSIONS
  CB interventions yield long-term improvements in pain, disability and quality of life in comparison to no treatment and other guideline-based active treatments for patients with LBP of any duration and of any age.
  
  
  BACKGROUND
  PROSPERO protocol registration number: CRD42014010536.
authors.affiliation: Centre for Rehabilitation Research, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Richmond
authors.affiliation: Centre for Rehabilitation Research, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom; The George Institute for Global Health, University of Oxford, Oxford, England, United Kingdom.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Hall
authors.affiliation: Centre for Rehabilitation Research, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom.
authors.forename: Bethan
authors.initials: B
authors.lastname: Copsey
authors.affiliation: Centre for Rehabilitation Research, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom.
authors.forename: Zara
authors.initials: Z
authors.lastname: Hansen
authors.affiliation: Centre for Rehabilitation Research, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom.
authors.forename: Esther
authors.initials: E
authors.lastname: Williamson
authors.affiliation: Centre for Rehabilitation Research, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom.
authors.forename: Nicolette
authors.initials: N
authors.lastname: Hoxey-Thomas
authors.affiliation: Department of Psychiatry, Medical Sciences Division, Warneford Hospital, Oxford, United Kingdom.
authors.forename: Zafra
authors.initials: Z
authors.lastname: Cooper
authors.affiliation: Centre for Rehabilitation Research, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Lamb
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004185:Disability Evaluation; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D010147:Pain Measurement; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome