title: A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain (NCT00373867).
abstract: Psychological factors consistent with fear-avoidance models are associated with the development of chronic low back pain (LBP). As a result, graded activity (GA) and graded exposure (GX) have been suggested as behavioral treatment options. This clinical trial compared the effectiveness of treatment-based classification (TBC) physical therapy alone to TBC augmented with GA or GX for patients with acute and sub-acute LBP. Our primary hypothesis was that GX would be most effective for those with elevated pain-related fear. In total, 108 patients enrolled in this clinical trial and were randomly assigned to receive TBC, GA, or GX. Outcomes were assessed by a blinded evaluator at 4 weeks and by mail at 6 months. The primary outcomes for this trial were disability and pain intensity, and the secondary outcomes were fear-avoidance beliefs, pain catastrophizing, and physical impairment. There were no differences in 4-week and 6-month outcomes for reduction of disability, pain intensity, pain catastrophizing, and physical impairment. GX and TBC were associated with larger reductions in fear-avoidance beliefs at 6 months only. Six-month reduction in disability was associated with reduction in pain intensity, while 6-month reduction in pain intensity was associated with reductions in fear-avoidance beliefs and pain catastrophizing. This trial suggests that supplementing TBC with GA or GX was not effective for improving important outcomes related to the development of chronic LBP.
authors.affiliation: Department of Physical Therapy, University of Florida, Health Science Center, Gainesville, P.O. Box 100154, FL 32610-0154, USA Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA Department of Physical Therapy, SHANDS Rehab, Gainesville, FL, USA.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
authors.forename: Giorgio
authors.initials: G
authors.lastname: Zeppieri
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Cere
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Cere
authors.forename: Michael S
authors.initials: MS
authors.lastname: Borut
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hodges
authors.forename: Dalton M
authors.initials: DM
authors.lastname: Reed
authors.forename: Carolina
authors.initials: C
authors.lastname: Valencia
authors.forename: Michael E
authors.initials: ME
authors.lastname: Robinson
mesh_terms: D000208:Acute Disease; D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000534:rehabilitation*; D008297:Male; D010147:Pain Measurement; D026761:Physical Therapy Specialty / Q000379:methods*; D016896:Treatment Outcome
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