Ready or Not? Applying the Transtheoretical Model of Change on Return-to-Work Following CBT for Chronic Low Back Pain.

IF 2.7 3区医学 Q1 REHABILITATION

Journal of Occupational Rehabilitation Pub Date : 2026-07-17 DOI:10.1007/s10926-026-10432-5

Maria Frøseth Rosenblom, Henrik Børsting Jacobsen, Silje Endresen Reme

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引用次数: 0

Abstract

Purpose: Chronic low back pain (CLBP) is a leading cause of work-related disability with limited benefit from biomedical treatments. Multidisciplinary approaches, including cognitive-behavioral therapy (CBT) show promise, but outcomes may depend on readiness to change. The Transtheoretical Model may help identify who benefits most, yet its relevance for return-to-work (RTW) outcomes in CLBP remains underexplored. This secondary analysis of a randomized controlled trial examined whether readiness to change, measured by the Pain Stages of Change Questionnaire (PSOCQ), was associated with back pain intensity and disability, and whether it predicted RTW 12 months after a multidisciplinary intervention for CLBP.

Methods: 414 participants on long-term sick leave due to CLBP were randomized to either: brief intervention (BI), BI + CBT, BI + seal oil, or BI + soy oil. Baseline measures included PSOCQ, pain intensity, and Oswestry Disability Index. RTW was assessed via registry data at 12 months.

Results: Hierarchal regression showed that higher precontemplation scores were significantly associated with greater baseline back pain and disability, while higher maintenance scores were linked to less back pain. In the CBT group, logistic regression revealed that higher precontemplation scores significantly predicted a 63% reduction in odds of RTW.

Conclusion: Readiness to change is associated with pain intensity and disability cross-sectionally, and RTW 12 months following CBT, with less ready individuals experiencing more pain and lower RTW. Assessing stage of change may help tailor rehabilitation and identify those less likely to benefit from CBT.

Clinical trial registration: This study was registered with ClinicalTrials.gov (Identifier: NCT00463970) 2007-04-19.

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准备好了吗？应用跨理论模型：CBT治疗慢性腰痛后重返工作

目的：慢性腰痛（CLBP）是与工作有关的残疾的主要原因，生物医学治疗的益处有限。包括认知行为疗法（CBT）在内的多学科方法显示出希望，但结果可能取决于改变的意愿。跨理论模型可能有助于确定谁受益最大，但其与CLBP中重返工作（RTW）结果的相关性仍未得到充分探讨。这项随机对照试验的二次分析研究了通过疼痛变化阶段问卷（PSOCQ）测量的改变准备程度是否与背部疼痛强度和残疾有关，以及它是否预测了CLBP多学科干预后12个月的RTW。方法：414名因CLBP而长期病假的参与者随机分为：短期干预（BI）、BI + CBT、BI +海豹油或BI +豆油。基线测量包括PSOCQ、疼痛强度和Oswestry残疾指数。在12个月时通过注册数据评估RTW。结果：层次回归显示，较高的预思考评分与更大的基线背痛和残疾显著相关，而较高的维持评分与更少的背痛相关。在CBT组中，逻辑回归显示，较高的预思考得分显著预测RTW几率降低63%。结论：改变的准备程度与疼痛强度、残疾和CBT后12个月的RTW相关，准备程度较低的个体经历更多的疼痛和更低的RTW。评估改变的阶段可能有助于定制康复，并确定那些不太可能从CBT中获益的人。临床试验注册：本研究已在ClinicalTrials.gov（标识符：NCT00463970） 2007-04-19注册。

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来源期刊

Journal of Occupational Rehabilitation Multiple-

CiteScore

5.80

自引率

12.10%

发文量

期刊介绍： The Journal of Occupational Rehabilitation is an international forum for the publication of peer-reviewed original papers on the rehabilitation, reintegration, and prevention of disability in workers. The journal offers investigations involving original data collection and research synthesis (i.e., scoping reviews, systematic reviews, and meta-analyses). Papers derive from a broad array of fields including rehabilitation medicine, physical and occupational therapy, health psychology and psychiatry, orthopedics, oncology, occupational and insurance medicine, neurology, social work, ergonomics, biomedical engineering, health economics, rehabilitation engineering, business administration and management, and law. A single interdisciplinary source for information on work disability rehabilitation, the Journal of Occupational Rehabilitation helps to advance the scientific understanding, management, and prevention of work disability.