Open Access Open Badges Study protocol

Design considerations of a randomized clinical trial on a cognitive behavioural intervention using communication and information technologies for managing chronic low back pain

Julio Domenech12*, Rosa Baños3, Lourdes Peñalver4, Azucena Garcia-Palacios5, Rocio Herrero5, Aida Ezzedine4, Monica Martinez-Diaz4, Javier Ballester4, Jaime Horta4 and Cristina Botella5

Author Affiliations

1 Orthopaedic Surgery Department, Hospital Arnau de Vilanova, C/ San Clemente, 46015, Valencia, Spain

2 Faculty of Health Sciences, University Cardenal Herrera CEU, Valencia, Spain

3 Department of Personality, Evaluation and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain

4 Department of Physical Therapy and Rehabilitation, Hospital Arnau de Vilanova, Valencia, Spain

5 Department of Clinical and Basic Psychology and Biopsychology, Faculty of Psychology, University Jaume I, Castellon, Spain

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BMC Musculoskeletal Disorders 2013, 14:142  doi:10.1186/1471-2474-14-142

Published: 22 April 2013



Psychological treatments have been successful in treating chronic low back pain (CLBP). However, the effect sizes are still modest and there is room for improvement. A way to progress is by enhancing treatment adherence and self-management using information and communication technologies (ICTs). Therefore, the objective of this study was to design a trial investigating the short- and long-term efficacy of cognitive behavioural treatment (CBT) for CLBP using or not ICTs. A secondary objective of this trial will be to evaluate the influence of relevant variables on treatment response. Possible barriers in the implementation of CBT with and without ICT will also be investigated.


A randomised controlled trial with 180 CLBP patients recruited from specialised care will be conducted. Participants will be randomly assigned to three conditions: Control group (CG), CBT, and CBT supported by ICTs (CBT + ICT). Participants belonging to the three conditions will receive a conventional rehabilitation program (back school). The CBT group program will last six sessions. The CBT + ICT group will use the internet and SMS to practice the therapeutic strategies between sessions and in the follow-ups at their homes. Primary outcome variables will be self-reported disability and pain intensity. Assessment will be carried out by blinded assessors in five moments: pre-treatment, post-treatment and 3-, 6-, and 12-month follow-ups. The influence of catastrophizing, fear-avoidance beliefs, anxiety and depression in response to treatment in the primary outcomes will also be analysed.


This study will show data of the possible benefits of using ICTs in the improvement of CBT for treating CLBP.

Trial registration, NCT01802671

Low back pain; Cognitive behavioural therapy; Physical therapy; Information and communication technologies