Benefits of treatment theory in the design of explanatory trials: Cognitive treatment of illness perceptions in chronic low back pain rehabilitation as an illustrative example

Background: Evidence-based treatment is not effective for all patients. Research must therefore be carried out to help clinicians to decide for whom and under what circumstances certain treatment is effective. Treatment theory can assist in designing research that will provide results on which clinical decision-making can be based.

Objective: To illustrate how treatment theory can be helpful in the design of explanatory trials that assist clinical decision-making.

Methods: The benefit of treatment theory was demonstrated by approaching the design of a clinical trial from two perspectives: one without the use of treatment theory and one with the explicit use of treatment theory. Evaluation of the effectiveness of cognitive treatment of illness perceptions for patients with chronic low back pain was used as an illustrative example.

Issues: With treatment theory as the main focus, the intervention became the starting point for the design of an explanatory trial. Potentially relevant patient selection criteria, essential treatment components, the optimal choice of a control group and the selection of outcome measures were specified.

Conclusion: This paper not only describes problems encountered in research on the effectiveness of treatment, but also ways in which to address these problems.