Patient Perspectives on Participation in Cognitive Functional Therapy for Chronic Low Back Pain

被引:48
|
作者
Bunzli, Samantha [1 ,2 ]
McEvoy, Sarah [3 ]
Dankaerts, Wim [4 ]
O'Sullivan, Peter [5 ]
O'Sullivan, Kieran [3 ]
机构
[1] Univ Melbourne, St Vincents Hosp, Dept Surg, Melbourne, Vic, Australia
[2] Clinical Sci Bldg,29 Regent St, Fitzroy, Vic 3065, Australia
[3] Univ Limerick, Dept Clin Therapies, Limerick, Ireland
[4] Katholieke Univ Leuven, Fac Kinesiol & Rehabil, Dept Rehabil Sci, Musculoskeletal Unit, Leuven, Belgium
[5] Curtin Univ, Sch Physiotherapy & Exercise Sci, Perth, WA, Australia
来源
PHYSICAL THERAPY | 2016年 / 96卷 / 09期
关键词
CHRONIC MUSCULOSKELETAL PAIN; RANDOMIZED CONTROLLED-TRIAL; OF-THE-ART; SELF-EFFICACY; TAMPA SCALE; DISABILITY; BELIEFS; PEOPLE; MODEL; FEAR;
D O I
10.2522/ptj.20140570
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background. Cognitive functional therapy (CFT) has been shown to reduce pain and disability in people with chronic low back pain. Objectives. The purpose of this study was to investigate participants' experience of CFT by comparing participants who reported differing levels of improvement after participation in CFT, potentially yielding insight into the implementation of this approach. Design. This was a noninterventional, cross-sectional, qualitative study with an interpretive description framework. Methods. Individuals who had participated in CFT in 2 physical therapy settings (in Ireland and Australia) were recruited through purposive sampling based on disability outcomes postintervention (n=9), and theoretical sampling (n=5). This sampling strategy was used to capture a range of participant experiences but was not used to define the final qualitative groupings. Semistructured interviews were conducted 3 to 6 months postintervention. Results. Three groups emerged from the qualitative analysis: large improvers, small improvers, and unchanged. Two themes encapsulating the key requirements in achieving a successful outcome through CFT were identified: (1) changing pain beliefs and (2) achieving independence. Changing pain beliefs to a more biopsychosocial perspective required a strong therapeutic affiance, development of body awareness, and the experience of control over pain. Independence was achieved by large improvers through newly cultivated problem-solving skills, self-efficacy, decreased fear of pain, and improved stress coping. Residual fear and poor stress coping meant that small improvers were easily distressed and lacked independence. Those who were unchanged continued to feel defined by their pain and retained a biomedical perspective. Conclusions. A successful outcome after CFT is dependent on instilling biopsychosocial pain beliefs and developing independence among participants. Small improvers may require ongoing support to maintain results. Further study is needed to elucidate the optimal approach for those who were unchanged.
引用
收藏
页码:1397 / 1407
页数:11
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