Psychological interventions for chronic non-specific low back pain: protocol of a systematic review with network meta-analysis

Emma Ho; Manuela Ferreira; Lingxiao Chen; Milena Simic; Claire Ashton-James; Josielli Comachio; Jill Hayden; Paulo Ferreira

doi:10.1136/bmjopen-2019-034996

Psychological interventions for chronic non-specific low back pain: protocol of a systematic review with network meta-analysis

BMJ Open. 2020 Sep 17;10(9):e034996. doi: 10.1136/bmjopen-2019-034996.

Authors

Emma Ho¹, Manuela Ferreira², Lingxiao Chen², Milena Simic³, Claire Ashton-James⁴, Josielli Comachio^{3

5}, Jill Hayden⁶, Paulo Ferreira³

Affiliations

¹ Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia emma.ho@sydney.edu.au.
² Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
³ Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁴ Pain Management Research Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁵ Department of Speech, Physical Therapy and Occupational Therapy, School of Medicine, University of Sao Paulo, Sao Paulo, São Paulo, Brazil.
⁶ Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.

Abstract

Introduction: Psychological factors such as fear avoidance beliefs, depression, anxiety, catastrophic thinking and familial and social stress, have been associated with high disability levels in people with chronic low back pain (LBP). Guidelines endorse the integration of psychological interventions in the management of chronic LBP. However, uncertainty surrounds the comparative effectiveness of different psychological approaches. Network meta-analysis (NMA) allows comparison and ranking of numerous competing interventions for a given outcome of interest. Therefore, we will perform a systematic review with a NMA to determine which type of psychological intervention is most effective for adults with chronic non-specific LBP.

Methods and analysis: We will search electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS and CINAHL) from inception until 22 August 2019 for randomised controlled trials comparing psychological interventions to any comparison interventions in adults with chronic non-specific LBP. There will be no restriction on language. The primary outcomes will include physical function and pain intensity, and secondary outcomes will include health-related quality of life, fear avoidance, intervention compliance and safety. Risk of bias will be assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2) tool and confidence in the evidence will be assessed using the Confidence in NMA (CINeMA) framework. We will conduct a random-effects NMA using a frequentist approach to estimate relative effects for all comparisons between treatments and rank treatments according to the mean rank and surface under the cumulative ranking curve values. All analyses will be performed in Stata.

Ethics and dissemination: No ethical approval is required. The research will be published in a peer-reviewed journal.

Prospero registration number: CRD42019138074.

Keywords: back pain; musculoskeletal disorders; psychiatry.

MeSH terms

Adult
Humans
Low Back Pain* / therapy
Meta-Analysis as Topic
Network Meta-Analysis
Psychosocial Intervention
Quality of Life
Systematic Reviews as Topic