Reviewer's report
Title: Active rehabilitation for chronic low back pain: Cognitive-behavioral, physical, or both? A
randomized controlled trial. First direct post-treatment results [ISRCTN22714229]
Version: 1 Date: 2 August 2005
Reviewer: Alex Burdorf
Reviewer's report:
General
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Major Compulsory Revisions (that the author must respond to before a decision on publication can
be reached)
1. My main point of concern is the conclusion. The results could be interpreted that
APT and CT are preferential to CBT since physical performance improves. Given the
background of the three models one could even conclude that APT is thus to be preferred,
it seems to do what CBT does for the endpoints if interest and, in additon, improves
physical health. I strongly suggest to raise this clearly in the discussion (and maybe
change the remark on physical performance in the abstract since it seems that the authors
do not think this result carries any weight)
2. Disussion; some attention must be paid to the WL group as reference group. This is
often debated, since placing persons on the WL may have an adverse effect. In this RCT
it could be hypothezised that those on the WL did not change in their condition, whereas any
other form of treatment (paying attention, holding hands, whatever) was bound to
show an effect anyway.
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the
author can be trusted to correct)
1. there is quite a debate about terminology in this area. Although the RDQ refers
to disability in its name, it may be better described as functional limitations
2. I assume that the linear regression analyses were indeed based on a mixed model
to account for within-group variance and repeated measures within the same subjects ?
3. Assessment: state clearly the duration of each treatment protocol to ensure that
the comparison with the 10 weeks WL-group is adequate
4. Results: I would like to start the analysis with a clear statement that the
analysis within the WL group showed no time trend and, thus, the comparison
after treatment with other groups is allowed.
5. discussion: at baseline work status was ascertained, it would have been nice
to see whether this changed during the treatment (since RTW may be affected,
even within a 10 week period)
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Discretionary Revisions (which the author can choose to ignore)
What next?: Accept after minor essential revisions
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes
Declaration of competing interests:
I declare that I have no competing interests