Background to the study

Back pain is consistently among the top three disabling conditions in developed countries (Savigny, 2009).  Advice to remain active delivered in primary care, while having benefits, is often short-lived (Pengel, 2007).  Physical treatments such as structured exercise and postural approaches alone, typically have non-significant long-term benefits (e.g. Little, 2008, UK BEAM Trial, 2004).

NICE guidelines (2009) recommend supervised exercise therapy delivered within a cognitive behavioural (CBT) framework, as a first-line treatment in the management of chronic low back pain.

In addition, a recent randomised controllled trial evaluating a group CBT programme plus exercise therapy for patients with low back pain, showed benefits of treatment were maintained after 12 months follow-up (Lamb et al, 2010).  

Pain Disability Prevention Study:

This trial will use a similar approach.  Specifically we will trial a 10 week, one-to-one programme focusing on active rehabilitation using graded exercise and activity pacing supported by a cognitive behavioural approach. 

This structured 10 week programme called the Progressive Goal Attainment Programme (PGAP) has demonstrated efficacy in the Canadian health service.  We are now evaluating the programme within the Irish Health Service.  

PGAP targets modifiable factors which may reduced rehabilitation progress.  In particular, the intervention will target those individuals with thought patterns and behaviours ('yellow flags'), which are known to increase risk for chronic disability.  The intervention will be delivered locally, to suitable patients, by psychologists trained in pain management.

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