Does group-based cognitive therapy improve functional ability, pain, catastrophic thoughts and quality of life in patients with persistent low back pain and psychological risk factors? A randomised controlled trial in a secondary care setting

Clin Rehabil. 2022 Mar;36(3):317-330. doi: 10.1177/02692155211056202. Epub 2021 Dec 30.


Objective: To investigate the effects of a group-based cognitive behavioural intervention for patients with persistent low back pain (LBP) and psychological risk factors referred to secondary care.

Design: A randomised controlled trial.

Setting: Silkeborg Regional Hospital, Denmark.

Subjects: A total of 136 participants with chronic LBP and psychological risk factors.

Interventions: Participants were randomised to the standard care group, including examination by a rheumatologist and/or a physiotherapist, or the intervention group, including standard care plus a multidisciplinary group-based pain management programme.

Main measures: Patient-reported outcomes were collected at baseline and after 6 and 12 months. The primary outcome was disability (Roland Morris Disability Questionnaire). Secondary outcomes included low back pain intensity, pain catastrophising, health-related quality of life, and sick leave.

Results: Among 136 participants, 68 (mean age: 41.7 years (SD 11.8)) were randomised to standard care and 68 (mean age: 46.0 years (SD 10.8)) were randomised to the intervention group. Except for age, baseline characteristics were comparable between groups. 12-month follow-up was completed by 92.6% in the intervention group and 80.9% in the standard care group. Both groups achieved significant improvements on disability, with a reduction of -4.8 points (SD 6.1) in the intervention group compared to -3.7 points (SD 5.2), resulting in an insignificant difference between groups. No significant differences were found in the secondary outcomes.

Conclusion: A group-based pain management programme was no more effective than standard care for patients with persistent LBP and psychological risk factors.

Keywords: Low back pain; disability; psychological factors; randomized controlled trial; rehabilitation interventions.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cognitive Behavioral Therapy*
  • Humans
  • Low Back Pain* / diagnosis
  • Low Back Pain* / therapy
  • Middle Aged
  • Quality of Life
  • Risk Factors
  • Secondary Care
  • Treatment Outcome