2023-05-03 アイルランド・リムリック大学(UL)
◆このアプローチは、認知機能療法(Cognitive Functional Therapy, CFT)と呼ばれ、背中の痛みの原因についての個人的なケアを提供し、患者自身が痛みを理解し、自己管理することを手助けする。研究により、このアプローチが背中の痛みの大幅な改善をもたらすことが示された。CFTは、これまでに3回のランダム化臨床試験で検証され、背中の痛みに対する効果が証明されている。
◆このアプローチは、身体的・非身体的要因の両方を対処する必要があることを再確認するものである。しかし、このアプローチを実施するためには、訓練期間が必要であることや、背中の痛みは世界で最も多くの障害の原因の1つであり、現在、患者に効果のない治療が提供されていることが課題である。
<関連情報>
- https://www.ul.ie/news/ul-research-shows-personalised-care-approach-to-back-pain-is-highly-effective
- https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/fulltext
慢性腰痛症に対する認知機能療法と運動センサーバイオフィードバック併用療法と通常療法の比較(RESTORE):無作為化、対照、3群、並行群、第3相、臨床試験 Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial
Peter Kent, Terry Haines, Peter O’Sullivan, Anne Smith, Amity Campbell, Robert Schutze, Stephanie Attwell, J P Caneiro, Robert Laird, Kieran O’Sullivan, Alison McGregor, Jan Hartvigsen, Den-Ching A Lee, Alistair Vickery, Mark Hancock, on behalf of the RESTORE trial team
The Lancet Published:May 02, 2023
DOI:https://doi.org/10.1016/S0140-6736(23)00441-5
Summary
Background
Low back pain is the leading cause of years lived with disability globally, but most interventions have only short-lasting, small to moderate effects. Cognitive functional therapy (CFT) is an individualised approach that targets unhelpful pain-related cognitions, emotions, and behaviours that contribute to pain and disability. Movement sensor biofeedback might enhance treatment effects. We aimed to compare the effectiveness and economic efficiency of CFT, delivered with or without movement sensor biofeedback, with usual care for patients with chronic, disabling low back pain.
Methods
RESTORE was a randomised, controlled, three-arm, parallel group, phase 3 trial, done in 20 primary care physiotherapy clinics in Australia. We recruited adults (aged ≥18 years) with low back pain lasting more than 3 months with at least moderate pain-related physical activity limitation. Exclusion criteria were serious spinal pathology (eg, fracture, infection, or cancer), any medical condition that prevented being physically active, being pregnant or having given birth within the previous 3 months, inadequate English literacy for the study’s questionnaires and instructions, a skin allergy to hypoallergenic tape adhesives, surgery scheduled within 3 months, or an unwillingness to travel to trial sites. Participants were randomly assigned (1:1:1) via a centralised adaptive schedule to usual care, CFT only, or CFT plus biofeedback. The primary clinical outcome was activity limitation at 13 weeks, self-reported by participants using the 24-point Roland Morris Disability Questionnaire. The primary economic outcome was quality-adjusted life-years (QALYs). Participants in both interventions received up to seven treatment sessions over 12 weeks plus a booster session at 26 weeks. Physiotherapists and patients were not masked. This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12618001396213.
Findings
Between Oct 23, 2018 and Aug 3, 2020, we assessed 1011 patients for eligibility. After excluding 519 (51·3%) ineligible patients, we randomly assigned 492 (48·7%) participants; 164 (33%) to CFT only, 163 (33%) to CFT plus biofeedback, and 165 (34%) to usual care. Both interventions were more effective than usual care (CFT only mean difference –4·6 [95% CI –5·9 to –3·4] and CFT plus biofeedback mean difference –4·6 [–5·8 to –3·3]) for activity limitation at 13 weeks (primary endpoint). Effect sizes were similar at 52 weeks. Both interventions were also more effective than usual care for QALYs, and much less costly in terms of societal costs (direct and indirect costs and productivity losses; –AU$5276 [–10 529 to –24) and –8211 (–12 923 to –3500).
Interpretation
CFT can produce large and sustained improvements for people with chronic disabling low back pain at considerably lower societal cost than that of usual care.
Funding
Australian National Health and Medical Research Council and Curtin University.
