Can physical therapy centred on cognitive and behavioural principles improve pain self-efficacy in symptomatic lumbar isthmic spondylolisthesis? A case series

Abstract

Purpose: Pain-related self-efficacy is defined as "the beliefs held by people with chronic pain that were able to carry out certain activities, even when experiencing pain", and it is considered a relevant mediator in the relationship between pain and disability in chronic low back pain. This case series describes a treatment aiming to improve pain self-efficacy in patients with symptomatic lumbar spondylolisthesis.

Method: Ten consecutive outpatients with lumbar spondylolisthesis and chronic LBP referred to a rehabilitative clinic participated in this study. Cognitive and behavioural principles were integrated with functional and graded approach in each individual physical therapy program. The outcome measures concerned clinical instability and endurance tests, pain, disability and self-efficacy.

Results: Pain self-efficacy and lumbar function improved in 7 out of 10 patients; clinical tests improved in 9 out of 10 patients.

Conclusion: A rehabilitation program carried out by a physical therapist, centred on cognitive and behavioural principles, appeared useful in improving pain self-efficacy and lumbar function. These results may be interesting for future controlled trials.

Keywords: Chronic low back pain; Cognitive-behavioural treatment; Exercise movement techniques; Exercise therapy; Physical therapy modalities.