Exercise facilitation method using cognitive behavioral therapy tools for chronic low back pain

Background & Aims

The combination of exercise and cognitive behavioral therapy (CBT) for chronic pain has been reported to be more effective than exercise alone(1). Therefore, “Ikiiki Rehabilitation Notebook?ikiiki-reha note? ” was developed in Japan so that general therapists can also implement exercise therapy combined with cognitive behavioral therapy(2). “Ikiiki” means active in Japanese. The aim of this study was to clarify the usefulness of an exercise promotion method that combines patient education and exercise therapy using the ikiiki-reha note, developed as a cognitive behavioral therapy tool, for patients with refractory chronic low back pain at our hospital.

Methods

Subjects were patients with chronic low back pain persisting for more than six months, who were resistant to other conservative treatments (pain-relief drug, interventional treatment, general exercise therapy, etc.). Of the 14 patients who obtained informed consent to participate in this study for the 2-year period from September 2019, 10 patients (average 65 y.o., 9 women) underwent treatment intervention for more than 3 months. The average duration of intervention was 4.8 months (range: 3-9 mos). The treatment method consists of supervised physical exercise by a therapist every two weeks, as well as voluntary exercise at home and a cognitive behavioral therapy intervention in which patients fill out the ikiiki-reha note every day. Before and after treatment intervention, numerical rating scale (NRS) pain score, pain disability assessment scale (PDAS), pain self-efficacy questionnaire (PSEQ), pain catastrophizing scale (PCS), euroqol 5 dimension (EQ-5D) were statistically evaluated.

Results

NRS pain score of maximum daily pain significantly decreased from 7.3 ± 1.2 (mean ± standard deviation) to 3.6 ± 2.0, and the amount of analgesics used was reduced in 5 patients. PDAS, PSEQ, PCS, and EQ-5D significantly improved from 31.4±9.4 to 23.7±8.1, from 23.3±14.0 to 32.6±7.2, from 33.5±11.5 to 28.3±11.1, and from 0.414±0.201 to 0.66±0.118, respectively.

Conclusions

These results showed that the exercise promotion method using the “Ikiiki Rehabilitation Notebook”, developed as a cognitive behavioral therapy tool, for refractory chronic low back pain improved not only chronic pain but also psychological aspects and physical activity, and then quality of life.

References

(1)Hajihasani A, Rouhani M, Salavati M, et al.: The Influence of Cognitive Behavioral Therapy on Pain, Quality of Life, and Depression in Patients Receiving Physical Therapy for Chronic Low Back Pain: A Systematic Review. PM R 2019; 11: 167-176.
(2)Kimura S, Hosoi M, Otsuru N, et al. A Novel Exercise Facilitation Method in Combination with Cognitive Behavioral Therapy Using the Ikiiki Rehabilitation Notebook for Intractable Chronic Pain: Technical Report and 22 Cases.: Healthcare (Basel). 2021 Sep 14;9(9):1209. doi: 10.3390/healthcare9091209.

Presenting Author