Objective To determine the comparative effectiveness and safety of psychological interventions for chronic low back pain. Design Systematic review with network meta-analysis. Data sources Medline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, and CINAHL from database inception to 31 January 2021. Eligibility criteria for study selection Randomised controlled trials comparing psychological interventions with any comparison intervention in adults with chronic, non-specific low back pain. Two reviewers independently screened studies, extracted data, and assessed risk of bias and confidence in the evidence. Primary outcomes were physical function and pain intensity. A random effects network meta-analysis using a frequentist approach was performed at post-intervention (from the end of treatment to <2 months post-intervention); and at short term (≥2 to <6 months post-intervention), mid-term (≥6 to <12 months post-intervention), and long term follow-up (≥12 months post-intervention). Physiotherapy care was the reference comparison intervention. The design-by-treatment interaction model was used to assess global inconsistency and the Bucher method was used to assess local inconsistency. Results 97 randomised controlled trials involving 13 136 participants and 17 treatment nodes were included. Inconsistency was detected at short term and mid-term follow-up for physical function, and short term follow-up for pain intensity, and were resolved through sensitivity analyses. For physical function, cognitive behavioural therapy (standardised mean difference 1.01, 95% confidence interval 0.58 to 1.44), and pain education (0.62, 0.08 to 1.17), delivered with physiotherapy care, resulted in clinically important improvements at post-intervention (moderate quality evidence). The most sustainable effects of treatment for improving physical function were reported with pain education delivered with physiotherapy care, at least until mid-term follow-up (0.63, 0.25 to 1.00; low quality evidence). No studies investigated the long term effectiveness of pain education delivered with physiotherapy care. For pain intensity, behavioural therapy (1.08, 0.22 to 1.94), cognitive behavioural therapy (0.92, 0.43 to 1.42), and pain education (0.91, 0.37 to 1.45), delivered with physiotherapy care, resulted in clinically important effects at post-intervention (low to moderate quality evidence). Only behavioural therapy delivered with physiotherapy care maintained clinically important effects on reducing pain intensity until mid-term follow-up (1.01, 0.41 to 1.60; high quality evidence). Conclusions For people with chronic, non-specific low back pain, psychological interventions are most effective when delivered in conjunction with physiotherapy care (mainly structured exercise). Pain education programmes (low to moderate quality evidence) and behavioural therapy (low to high quality evidence) result in the most sustainable effects of treatment; however, uncertainty remains as to their long term effectiveness. Although inconsistency was detected, potential sources were identified and resolved. Systematic review registration PROSPERO CRD42019138074. Requests for data sharing should be sent to the corresponding authors: Emma K Ho (emma.ho{at}sydney.edu.au) or Lingxiao Chen (lche4036{at}uni.sydney.edu.au)

中文翻译：

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慢性非特异性腰痛的心理干预：网络荟萃分析的系统评价

目的比较心理干预治疗慢性腰痛的有效性和安全性。使用网络荟萃分析设计系统评价。数据来源 Medline、Embase、PsycINFO、Cochrane Central Register of Controlled Trials、Web of Science、SCOPUS 和 CINAHL，从数据库开始到 2021 年 1 月 31 日。研究选择的合格标准 比较心理干预与任何比较干预对成人慢性病患者进行的随机对照试验，非特异性腰痛。两名审查员独立筛选研究、提取数据并评估偏倚风险和证据的可信度。主要结果是身体功能和疼痛强度。在干预后（从治疗结束到< 干预后 2 个月）；以及短期（干预后≥2至<6个月）、中期（干预后≥6至<12个月）和长期随访（干预后≥12个月）。物理治疗护理是参考比较干预。设计-治疗交互模型用于评估全局不一致，Bucher 方法用于评估局部不一致。结果 共纳入 97 项随机对照试验，涉及 13 136 名受试者和 17 个治疗节点。在身体功能的短期和中期随访以及疼痛强度的短期随访中发现不一致，并通过敏感性分析解决。对于身体功能，认知行为疗法（标准化平均差 1.01，95% 置信区间 0.58 至 1.44）和疼痛教育（0.62，0.08 至 1.17），通过物理治疗护理，在干预后产生了重要的临床改善（中等质量证据）。据报道，治疗对改善身体功能的最可持续效果是通过物理治疗护理提供的疼痛教育，至少在中期随访之前（0.63, 0.25 至 1.00；低质量证据）。没有研究调查物理治疗护理提供的疼痛教育的长期有效性。对于疼痛强度，行为疗法（1.08, 0.22 至 1.94）、认知行为疗法（0.92, 0.43 至 1.42）和疼痛教育（0.91, 0.37 至 1.45）与物理治疗护理相结合，在干预后产生了重要的临床效果（低到中等质量的证据）。直到中期随访（1.01, 0.41 至 1.60；高质量证据），只有通过物理治疗护理提供的行为疗法在降低疼痛强度方面保持了临床上重要的效果。结论 对于患有慢性、非特异性腰痛的人，心理干预与物理治疗护理（主要是结构化锻炼）相结合时最有效。疼痛教育计划（低到中等质量证据）和行为治疗（低到高质量证据）产生最可持续的治疗效果；然而，它们的长期有效性仍存在不确定性。尽管检测到不一致，但仍确定并解决了潜在来源。系统评价注册PROSPERO CRD42019138074。数据共享请求应发送给相应的作者：Emma K Ho (emma.