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Graded exposure in de eerste lijn

  • R. M. A. van Erp
  • I. P. J. Huijnen
  • R. J. E. M. Smeets

Samenvatting

Steeds vaker worden biopsychosociale behandelprogramma’s met elementen van graded exposure aangeboden in de eerste lijn. In tegenstelling tot tweede- of derdelijnsbehandelprogramma’s, worden eerstelijnsbehandelprogramma’s meestal monodisciplinair aangeboden. Om een biopsychosociale behandeling in de eerste lijn goed tot zijn recht te laten komen, dient rekening te worden gehouden met drie factoren: (1) de patiënt (biopsychosociaal profiel en verwachtingen ten aanzien van therapie); (2) de therapeut (kennis, attitude en vaardigheden) en; (3) de praktijk (faciliteiten, planning en organisatie). Tevens kan het zinvol zijn elementen van graded exposure te combineren met elementen van andere cognitief-gedragsmatige benaderingen zoals graded activity. Hierdoor krijgt de patiënt die wordt behandeld in de eerste lijn, en die vaak minder complexe psychosociale problemen ervaart dan patiënten in de tweede of derde lijn, de gelegenheid te achterhalen welke factoren (lichamelijk, cognitief en/of omgeving) het pijnprobleem (deels) onderhouden en op welke manieren hij hiermee kan omgaan.

Literatuur

  1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):S192–300.Google Scholar
  2. Bano-Aledo ME del, Medina-Mirapeix F, Escolar-Reina P, Montilla-Herrador J, Collins SM. Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: a qualitative study. Physiotherapy. 2014;100(1):73–9.CrossRefPubMedGoogle Scholar
  3. Beurskens AJ, Vet HC de, Köke AJ, Lindeman E, Heijden GJ van der, Regtop W, et al. A patient-specific approach for measuring functional status in low back pain. J Manipulative Physiol Ther. 1999;22(3):144–8.CrossRefPubMedGoogle Scholar
  4. Fordyce WE. Behavioral methods for chronic pain and illness. St. Louis, MO: Mosby; 1976.Google Scholar
  5. Foster NE, Delitto A. Embedding psychosocial perspectives within clinical management of low back pain: integration of psychosocially informed management principles into physical therapist practice – challenges and opportunities. Phys Ther. 2011;91(5):790–803.CrossRefPubMedGoogle Scholar
  6. George SZ, Fritz JM, Bialosky JE, Donald DA. The effect of a fear-avoidance-based physical therapy intervention for patients with acute low back pain: results of a randomized clinical trial. Spine (Phila Pa 1976). 2003;28(23):2551–60.Google Scholar
  7. George SZ, Wittmer VT, Fillingim RB, Robinson ME. Comparison of graded exercise and graded exposure clinical outcomes for patients with chronic low back pain. J Orthop Sports Phys Ther. 2010;40(11):694–704.CrossRefPubMedGoogle Scholar
  8. Goossens ME, Vlaeyen JW, Hidding A, Kole-Snijders A, Evers SM. Treatment expectancy affects the outcome of cognitive-behavioral interventions in chronic pain. Clin J Pain. 2005;21(1):18–26; discussion 69–72.Google Scholar
  9. Hill JC, Dunn KM, Lewis M, Mullis R, Main CJ, Foster NE, et al. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum. 2008;59(5):632–41.CrossRefPubMedGoogle Scholar
  10. Houben RM, Ostelo RW, Vlaeyen JW, Wolters PM, Peters M. Stomp-van den Berg SG. Health care providers’ orientations towards common low back pain predict perceived harmfulness of physical activities and recommendations regarding return to normal activity. Eur J Pain. 2005;9(2):173–83.CrossRefPubMedGoogle Scholar
  11. Jellema P, Windt DA van der, Horst HE van der, Blankenstein AH, Bouter LM, Stalman WA. Why is a treatment aimed at psychosocial factors not effective in patients with (sub)acute low back pain? Pain. 2005a;118(3):350–9.CrossRefPubMedGoogle Scholar
  12. Jellema P, Windt DA van der, Horst HE van der, Twisk JW, Stalman WA, Bouter LM. Should treatment of (sub)acute low back pain be aimed at psychosocial prognostic factors? Cluster randomised clinical trial in general practice. BMJ. 2005b;331(7508):84.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, Tulder MW van. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev. 2014;9:CD000963.Google Scholar
  14. Köke A, Wilgen P, Engers A, Geilen M. Graded Activity. Houten: Bohn Stafleu van Loghum; 2007.CrossRefGoogle Scholar
  15. Lamb SE, Hansen Z, Lall R, Castelnuovo E, Withers EJ, Nichols V, et al. Back skills training trial, investigators. Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. Lancet. 2010a;375(9718):916–23.CrossRefPubMedGoogle Scholar
  16. Lamb SE, Lall R, Hansen Z, Castelnuovo E, Withers EJ, Nichols V, et al. A multicentred randomised controlled trial of a primary care-based cognitive behavioural programme for low back pain. The Back Skills Training (BeST) trial. Health Technol Assess. 2010b;14(41):1–253, iii–iv.Google Scholar
  17. Lamb SE, Mistry D, Lall R, Hansen Z, Evans D, Withers EJ, et al. Back skills training trial, Group. Group cognitive behavioural interventions for low back pain in primary care: extended follow-up of the Back Skills Training Trial (ISRCTN54717854). Pain. 2012;153(2):494–501.CrossRefPubMedGoogle Scholar
  18. Leeuw M, Goossens ME, Breukelen GJ van, Boersma K, Vlaeyen JW. Measuring perceived harmfulness of physical activities in patients with chronic low back pain: the photograph series of daily activities – short electronic version. J Pain. 2007;8(11):840–9.CrossRefPubMedGoogle Scholar
  19. Leeuw M, Goossens ME, Breukelen GJ van, Jong JR de, Heuts PH, Smeets RJ, et al. Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial. Pain. 2008;138(1):192–207.CrossRefPubMedGoogle Scholar
  20. Lindstrom I, Ohlund C, Eek C, Wallin L, Peterson LE, Fordyce WE, et al. The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach. Phys Ther. 1992;72(4):279–90; discussion 291–273.Google Scholar
  21. Linton SJ, Nicholas M, MacDonald S. Development of a short form of the orebro musculoskeletal pain screening questionnaire. Spine (Phila Pa 1976). 2011;36(22):1891–5.Google Scholar
  22. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011;92(12):2041–56.CrossRefPubMedGoogle Scholar
  23. Melloh M, Salathe CR, Elfering A, Kaser A, Barz T, Aghayev E, et al. Occupational, personal and psychosocial resources for preventing persistent low back pain. Int J Occup Saf Ergon. 2013;19(1):29–40.CrossRefPubMedGoogle Scholar
  24. Middelkoop M van, Rubinstein SM, Kuijpers T, Verhagen AP, Ostelo R, Koes BW, et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. Eur Spine J. 2011;20(1):19–39.CrossRefPubMedGoogle Scholar
  25. Monticone M, Ambrosini E, Rocca B, Magni S, Brivio F, Ferrante S. A multidisciplinary rehabilitation programme improves disability, kinesiophobia and walking ability in subjects with chronic low back pain: results of a randomised controlled pilot study. Eur Spine J. 2014;23(10):2105–13.CrossRefPubMedGoogle Scholar
  26. Nijs J, Wilgen PC van, Oosterwijck J van, Ittersum M van, Meeus M. How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: practice guidelines. Man Ther. 2011;16(5):413–8.Google Scholar
  27. Oosterwijck J van, Meeus M, Paul L, Schryver M de, Pascal A, Lambrecht L, et al. Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: a double-blind randomized controlled trial. Clin J Pain. 2013;29(10):873–82.CrossRefPubMedGoogle Scholar
  28. Overmeer T, Boersma K, Main CJ, Linton SJ. Do physical therapists change their beliefs, attitudes, knowledge, skills and behaviour after a biopsychosocially orientated university course? J Eval Clin Pract. 2009;15(4):724–32.CrossRefPubMedGoogle Scholar
  29. Smeets RJ, Beelen S, Goossens ME, Schouten EG, Knottnerus JA, Vlaeyen JW. Treatment expectancy and credibility are associated with the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. Clin J Pain. 2008;24(4):305–15.CrossRefPubMedGoogle Scholar
  30. Staal JBM, Hendriks EJ, Heijmans M, Kiers H, Lutgers-Boomsma AM, Rutten G, et al. KNGF-richtlijn Lage-rugpijn. Amersfoort: Drukkerij De Gans; 2013.Google Scholar
  31. Synnott A, O’Keeffe M, Bunzli S, Dankaerts W, O’Sullivan P, O’Sullivan K. Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review. J Physiother. 2015;61(2):68–76.CrossRefPubMedGoogle Scholar
  32. Turner-Stokes L, Erkeller-Yuksel F, Miles A, Pincus T, Shipley M, Pearce S. Outpatient cognitive behavioral pain management programs: a randomized comparison of a group-based multidisciplinary versus an individual therapy model. Arch Phys Med Rehabil. 2003;84(6):781–8.CrossRefPubMedGoogle Scholar
  33. Vlaeyen JW, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85(3):317–32.CrossRefPubMedGoogle Scholar

Copyright information

© Bohn Stafleu van Loghum 2017

Authors and Affiliations

  • R. M. A. van Erp
    • 1
  • I. P. J. Huijnen
    • 1
  • R. J. E. M. Smeets
    • 1
    • 2
    • 3
  1. 1.Adelante zorggroepHoensbroekThe Netherlands
  2. 2.Universiteit MaastrichtMaastrichtThe Netherlands
  3. 3.Libra Revalidatie en AudiologieUniversiteit MaastrichtMaastrichtThe Netherlands

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