Efektifitas Cognitive Behavioural Therapy dengan Therapeutic Exercise Program pada Pencegahan Chronic Low Back Pain: Meta-analisis

Arif Fadli; S. Th. Susilowati

doi:10.22146/jkesvo.61857

Efektifitas Cognitive Behavioural Therapy dengan Therapeutic Exercise Program pada Pencegahan Chronic Low Back Pain: Meta-analisis

https://doi.org/10.22146/jkesvo.61857

Arif Fadli^(1*), S. Th. Susilowati⁽²⁾

(1) Jurusan Fisioterapi, Politeknik Kesehatan Surakarta, Surakarta
(2) Jurusan Fisioterapi, Politeknik Kesehatan Surakarta, Surakarta
(*) Corresponding Author

Abstract

Latar Belakang: Nyeri menjadi keluhan utama seseorang mengunjungi fasilitas pelayanan kesehatan. Jumlah pasien Chronic Low Back Pain (CLBP) terus meningkat dan membutuhkan biaya perawatan kesehatan yang besar. Intervensi biomedis dianggap gagal menyelesaikan keluhan non-spesifik CLBP.

Tujuan: Untuk meringkas data literatur yang ada mengenai efektivitas Cognitive Behavioural Therapy (CBT) dengan Therapeutic Exercise Program (TEP) dalam pencegahan CLBP.

Metode: Systematic review dan meta-analisis studi Randomized Control Trial dari database Pubmed, Googlescholar, Willey Online Library, Research Gate, Science Direct. Analisis data menggunakan aplikasi Revman 5.3 dengan ukuran efek Cohen’s d.

Hasil: Ada 6 studi yang dimasukkan dalam penelitian ini. Hasil analisis 6 studi CBT dengan TEP dibandingkan dengan TEP saja pada intensitas nyeri menunjukkan ukuran efek yang besar (d: -1,51; 95%CI: -2,75 s/d -0,27; p <0,00001). Untuk parameter skor kecacatan menunjukkan ukuran efek yang besar (d: -1,87; 95% CI: -3,11 s/d -0,62; p <0,00001).

Kesimpulan: Intervensi CBT dengan TEP lebih efektif dari pada TEP saja dalam pencegahan CLBP. Efektivitas hasil pencegahan CLBP dipengaruhi oleh keberhasilan pasien dalam menyelesaikan program rehabilitasi.

Keywords

Efektivitas; CBT; TEP; CLBP; meta-analisis

Full Text:

PDF

References

Alaiti, R. K., Zuccolo, P. F., Hunziker, M. H. L., Caneiro, J. P., Vlaeyen, J. W. S., & Costa, M. F. da. (2020). Pain can be conditioned to voluntary movements through associative learning: an experimental study in healthy participants. Pain, 161(10), 2321–2329. https://doi.org/10.1097/j.pain.0000000000001919_

Aliyu, F. Y., Wasiu, A. A., & Bello, B. (2018). Effects of a combined lumbar stabilization exercise and cognitive behavioral therapy on selected variables of individuals with non-specific low back pain: A randomized clinical trial. Fisioterapia, 40(5), 257–260. https://doi.org/10.1016/j.ft.2018.07.002_

Bachrudin, M. (2017). Patofisiologi Nyeri. Saintika Medika, 13(1), 11–13. https://doi.org//10.22219/sm.v13i1.5449_

Chao, Y.-S., & Ford, C. (2019). Cognitive Behavioural Therapy for Chronic Non-Cancer Pain: A Review of Clinical Effectiveness. CADTH Rapid Response Report: Summary with Critical Appraisal. https://www.ncbi.nlm.nih.gov/books/NBK549547/_

Dinakar, P., & Stillman, A. M. (2016). Pathogenesis of Pain. Seminars in Pediatric Neurology, 23(3), 201–208. https://doi.org/10.1016/j.spen.2016.10.003_

Galán-Martín, M. A. F. M.-C., Lluch-Girbes, E., Coca-López, M. C., Mayo-Iscar, A., & Cuesta-Vargas, A. (2019). Pain neuroscience education and physical exercise for patients with chronic spinal pain in primary healthcare: A randomized trial protocol. BMC Musculoskeletal Disorders, 20(1), 1–8. https://doi.org/10.1186/s12891-019-2889-1_

Hasenbring, M. I., Rusu, A. C., & Turk, D. C. (2012). ‘Epidemiology of Back Pain, from the Laboratory to the Bus Stop : Psychosocial Risk Factors, Biological Mechanisms, and Interventions in Population-Based Research’, in From Acute to Chronic Back Pain : Risk Factors, Mechanisms, and Clinical Implications. Oxford University Press. https://doi.org/10.1093/med/9780199558902.001.0001_

Hjermstad, M. J., Fayers, P. M., Haugen, D. F., Caraceni, A., Hanks, G. W., Loge, J. H., Fainsinger, R., Aass, N., & Kaasa, S. (2011). Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: A systematic literature review. Journal of Pain and Symptom Management, 41(6), 1073–1093. https://doi.org/10.1016/j.jpainsymman.2010.08.016_

Khalid, S., & Tubbs, R. S. (2017). Neuroanatomy and Neuropsychology of Pain. Cureus, 9(10), 1–14. https://doi.org/10.7759/cureus.1754_

Khan, M., Akhter, S., Soomro, R. R., & Ali, S. S. (2014). The effectiveness of Cognitive Behavioral Therapy ( CBT ) with general exercises versus general exercises alone in the management of chronic low back pain. Pakistan Journal of Pharmaceutical Sciences, 27(4), 1113–1115. https://pubmed.ncbi.nlm.nih.gov/25016276/_

Lin, L., & Chu, H. (2018). ‘Quantifying Publication Bias in Meta-Analysis. Biometrics, 74(3), 785–791. https://doi.org/10.1111/biom.12817_

Louw, A., Puentedura, E. J., Zimney, K., & Schmidt, S. (2016). Know Pain, know gain? A perspective on pain neuroscience education in physical therapy. Journal of Orthopaedic and Sports Physical Therapy, 46(3), 131–134. https://doi.org/10.2519/jospt.2016.0602

Malfliet, A., Kregel, J., Meeus, M., Danneels, L., Cagnie, B., Roussel, N., & Nijs, J. (2018). Patients With Chronic Spinal Pain Benefit From Pain Neuroscience Education Regardless the Self-Reported Signs of Central Sensitization: Secondary Analysis of a Randomized Controlled Multicenter Trial. PM and R, 10(12), 1330–1343. https://doi.org/10.1016/j.pmrj.2018.04.010_

Manchikanti, L., Singh, V., Falco, F. J. E., Benyamin, R. M., & Hirsch, J. A. (2014). Epidemiology of low back pain in Adults. Neuromodulation, 17(S2), 3–7. https://doi.org/10.1111/ner.12018_

Murti, B. (2018). Prinsip dan Metodologi Riset Epidemiologi (5th ed.). Program Studi Ilmu Kesehatan Masyarakat, Program Pascasarjana, Universitas Sebelas Maret._

Neblett, R., Hartzell, M. M., Williams, M., Bevers, K. R., Mayer, T. G., & Gatchel, R. J. (2017). Use of the Central Sensitization Inventory (CSI) as a treatment outcome measure for patients with chronic spinal pain disorder in a functional restoration program. Spine Journal, 17(12), 1819–1825. https://doi.org/28619687_

Nicholas, M. K., Asghari, A., Blyth, F. M., Wood, B. M., Murray, R., McCabe, R., Brnabic, A., Beeston, L., Corbett, M., Sherrington, C., & Overton, S. (2013). Self-management intervention for chronic pain in older adults: a randomized controlled trial. Pain, 154(6), 824–831. https://doi.org/10.1016/j.pain.2013.02.009_

Nijs, J., Girbés, E. L., Lundberg, M., Malfliet, A., & Sterling, M. (2014). Exercise therapy for chronic musculoskeletal pain : Innovation by altering pain memories. Manual Therapy, 20(1), 1–3. https://doi.org/10.1016/j.math.2014.07.004_

O’Sullivan, P. B., Caneiro, J. P., O’Keeffe, M., Smith, A., Dankaerts, W., Fersum, K., & O’Sullivan, K. (2018). Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain. Physical Therapy, 98(5), 408–419. https://doi.org/10.1093/ptj/pzy022_

Retnawati, H., Apino, E., Kartianom, Djidu, H., & Anazifa, R. D. (2018). Pengantar Analisis Meta (E. Apino (ed.); 1st ed.). Parama Publishing._

Sedgwick, P. (2013). Meta-analyses : how to read a funnel plot. BMJ, 1342(March), 2. https://doi.org/10.1136/bmj.f1342_

Seminowicz, D. A., Shpaner, M., Keaser, M. L., Krauthamer, G. M., Mantegna, J., Dumas, J. A., Newhouse, P. A., Filippi, C. G., Keefe, F. J., & Naylor, M. R. (2013). Cognitive-Behavioral Therapy Increases Prefrontal Cortex Gray Matter in Patients With Chronic Pain. The Journal of Pain, 14(12), 1573–1578. https://doi.org/10.1016/j.jpain.2013.07.020_

Serrano, B., L, P. R., B, S., M, Z., ILS, T., F, F., & W, C. (2020). The hypnotic analgesia suggestion mitigated the effect of the transcranial direct current stimulation on the descending pain modulatory system: A proof of concept study. Journal of Pain Research, 13, 2297–2303. https://doi.org/10.2147/JPR.S253747_

Synnott, A., O’Keeffe, M., Bunzli, S., Dankaerts, W., O’Sullivan, P., Robinson, K., & O’Sullivan, K. (2016). Physiotherapists report improved understanding of and attitude toward the cognitive, psychological and social dimensions of chronic low back pain after Cognitive Functional Therapy training: a qualitative study. Journal of Physiotherapy, 62(4), 215–2219. https://doi.org/10.1016/j.jphys.2016.08.002_

Touche, R. La, Pérez-Fernández, M., Barrera-Marchessi, I., López-de-Uralde-Villanueva, I., Villafañe, J. H., Prieto-Aldana, M., Suso-Martí, L., & Paris-Alemany, A. (2019). Psychological and physical factors related to disability in chronic low back pain. Journal of Back and Musculoskeletal Rehabilitation, 32(4), 603–607. https://doi.org/10.3233/BMR-181269_

Velly, A. M., & Mohit, S. (2018). Epidemiology of pain and relation to psychiatric disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 87, 159–167. https://doi.org/10.1016/j.pnpbp.2017.05.012_

Villanueva, L. de U., Ibai, Beltran-Alacreu, H., Fernández-Carnero, J., & Touche, R. La. (2020). Pain management using a multimodal physiotherapy program including a biobehavioral approach for chronic non-specific neck pain: a randomized controlled trial. Physiotherapy Theory and Practice, 36(1), 45–62. https://doi.org/10.1080/09593985.2018.1480678

DOI: https://doi.org/10.22146/jkesvo.61857