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A Review of the Addition of Cognitive Behavioral Therapy to Physical Rehabilitation for Chronic Nonspecific Low Back Pain

Sequin, Elizabeth1; Joseph, Jennifer, MS, PA-C1; Cowen, Virginia S., PhD1

JBJS Journal of Orthopaedics for Physician Assistants: January-March 2019 - Volume 7 - Issue 1 - p e1
doi: 10.2106/JBJS.JOPA.18.00005
Review Articles

Background: Chronic nonspecific low back pain is common in adults in the United States. The assessment of nonpharmacologic treatment approaches is important in order to refer patients for optimal treatment. The addition of cognitive behavioral therapy (CBT) to physical rehabilitation may improve outcomes.

Methods: We performed a review of randomized controlled trials comparing physical rehabilitation plus CBT with physical rehabilitation alone.

Results: Six studies met the inclusion criteria; improvements were noted for all in both groups. Statistically significant differences between the groups were found in only 3 studies.

Conclusions: The findings were not robust, but they suggest that the addition of CBT may be beneficial as an adjuvant therapy.

1Physician Assistant Program (E.S.) and Department of Primary Care (J.J. and V.S.C.), School of Health Professions, Rutgers University, Piscataway, New Jersey

Investigation performed at the School of Health Professions, Rutgers University, Piscataway, New Jersey

Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated.
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