| dc.description.abstract | Evidence indicates that the current physiotherapy management of patients with chronic
non-specific LBP only offers moderate benefit. Combined treatment programmes,
addressing body as well as the mind, shows promising results in developed countries with
adequate resources but low evidence in poorly-resourced countries and contexts. This is
another gap in the existing knowledge. The study aimed to evaluate the effectiveness of a
combined physiotherapy and cognitive-behavioral therapy treatment, compared to
physiotherapy alone, in reducing pain, disability, mental health and fear-avoidance
behavior, in adults with non-specific low back pain. The systematic review included
articles published, in English only, between 1985-2018 (July) in the following databases
available at the University of The Western Cape: EbscoHost, BioMedCentral, Cambridge
Journals Online, CINAHL, Cochrane Library, Medline (EbscoHost), Medline (Pubmed),
Sabinet Reference, SAGE Journals Online, ScienceDirect,SciFinder Scholar, SCOPUS,
Wiley Online Library, Springerlink and PubMed.Two reviewers independently evaluated
the methodological quality of full text articles, using a critical appraisal tool. Fourteen (14)
articles were included based on methodological rigour. Five (5) articles were included in
the narrative synthesis and nine (9) articles were included in the meta-analyses. Statistically
significant improvements in pain, disability and mental health, in favour of combination
therapy for patients with chronic lower back pain were found. A small but statistically
significant cumulative effect size for mental health (g = -0.26, Z = -4.49, p <.01) , physical
disability (g = -0.27, Z = -5.09, p <.01) and pain (g = -.27, Z = -5.05, p <.01) , in favour of a
combination of cognitive behavioural therapy and physiotherapy in patients with chronic
lower back pain was found. In addition, a medium but statistically significant cumulative
effect size (g = -0.50, Z = -6.95, p <.01), in terms of fear avoidance, was found in favour of
the combination therapy. In conclusion, physiotherapy in combination with cognitivebehavioral
therapy was more effective than physiotherapy alone, in reducing pain,
disability, mental health and fear-avoidance behaviour, in adults with non-specific low
back pain. Ethics: Permission for the study was obtained from the university’s Biomedical
Research Ethics Committee. | en_US |
