Client-centered therapy vs exercise therapy for chronic low back pain: a pilot randomized controlled trial in Brazil.
BACKGROUND
Psychological interventions targeting maladaptive pain behaviors and depressive symptoms are commonly used in the management of chronic pain.


OBJECTIVE
To compare the effectiveness of psychotherapy, based on client-centered therapy, and exercise for patients with chronic nonspecific low back pain (LBP).


METHODS
Outpatient physiotherapy and psychotherapy departments within a Brazilian academic institution.


METHODS
Thirty-three patients with chronic nonspecific LBP were recruited and randomized to receive client-centered therapy (N = 16) or exercise (N = 17) for 9 weeks. OUTCOME MEASURES AND DATA ANALYSIS: Pain and disability were measured at baseline, 9 weeks, and 6 months by a 10-cm visual analog scale and by the Brazilian Roland-Morris Questionnaire, respectively. Depression was measured at baseline and 9 weeks by the Beck Depression Inventory. Multiple regression analyses with baseline scores as covariates were used to determine the effects of treatment on outcomes.


RESULTS
For all outcomes at each time point, the exercise group showed greater improvements than psychotherapy. The difference between groups was statistically and clinically significant for disability at 9 weeks (-4.9 points, 95% CI -9.08 to -0.72).


CONCLUSIONS
This was the first study to investigate the effects of client-centered therapy and exercise for patients with chronic LBP. Our results showed that client-centered therapy is less effective than exercise in reducing disability at short term.
Machado
Luciana A C
LA
Back Pain Research Group, School of Physiotherapy, University of Sydney, Sydney, New South Wales, Australia. lmac3689@mail.usyd.edu.au
Azevedo
Daniel C
DC
Capanema
Maria B
MB
Neto
Tuffi N
TN
Cerceau
Daniella M
DM
D000328:Adult; D001938:Brazil; D003863:Depression / Q000150:complications / Q000523:psychology; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010349:Patient Compliance; D009629:Person-Centered Psychotherapy; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome