Which patients with chronic low back pain respond favorably to multidisciplinary rehabilitation? A secondary analysis of a randomized controlled trial.

OBJECTIVES: The aim of this study was to identify prognostic variables at baseline associated with being responding favorably to multidisciplinary rehabilitation in patients with chronic low back pain (CLBP). METHODS: A responder analysis was conducted based on data from a randomized controlled trial with 26-week follow-up including 165 patients with CLBP treated at a Danish multidisciplinary rehabilitation center. Patients were dichotomized into responders and non-responders based on the outcome of a minimal clinically important difference of six points on the Oswestry Disability Index. The associations between prognostic variables and responders were analyzed using logistic regression. RESULTS: A total of 139 patients completed the study, of which 42% were classified as responders. Sex and employment status were statistically significant, with a decreased odds ratio (OR) of being a responder found for males compared to females (OR = 0.09, 95% CI = 0.02-0.48) and for being on temporary or permanent social benefits (OR = 0.28, 95% CI = 0.10-0.75) compared to being self-supporting or receiving retirement benefits. Statistically significant interaction (OR = 8.84, 95% CI = 1.11-70.12) was found between males and being on temporary or permanent social benefits. CONCLUSIONS: In patients with CLBP, female patients as well as patients who were self-supporting or receiving retirement benefits were significantly more likely than male patients or patients on temporary or permanent social benefits to be a responder to multidisciplinary rehabilitation.

Efectividad de los protocolos de fisioterapia para pacientes con dolor lumbar crónico. Una revisión sistemática / Effectiveness of physiotherapy protocols for patients with chronic low back pain: A systematic review

Introducción: El dolor lumbar crónico es una de las principales causas de incapacidad laboral en el mundo. Requiere un abordaje interdisciplinario para la evolución del paciente. Hasta el momento, no existe consenso en el manejo del dolor lumbar crónico, lo que generó la inquietud de esta revisión sistemática. Objetivo: Identificar la efectividad de los protocolos de fisioterapia en el manejo del dolor lumbar crónico. Metodología: Se realizó una búsqueda sistemática en las bases de datos Pubmed, ScienceDirect, Scopus, Oxford, Wiley, Cochrane Library Plus, PEDro, Epistemonikos, Hinari y LILACS, Google Scholar, Teseo y PROSPERO, desde el inicio de las bases hasta agosto de 2021. Los criterios de selección se definieron según la intervención y el tema del artículo. Resultados: Se incluyeron 26 estudios en la síntesis cualitativa, se excluyeron artículos que no cumplieran con los criterios de inclusión. Se encontró efecto en el control del dolor y la disminución de la discapacidad y las principales intervenciones son: fortalecimiento muscular del Core y miembros inferiores, estiramiento de miembros inferiores, movilidad lumbopélvica y educación o escuela de espalda. La frecuencia en el tratamiento osciló entre 2 y 3 veces por semana durante 5 semanas. Conclusiones: Se encontró mayor efectividad en el tiempo de control del dolor y la disminución de la discapacidad, relacionados principalmente con el fortalecimiento muscular del Core y las estrategias educativas.(AU)

Introduction: Chronic low back pain is one of the main causes of incapacity for work in the world. It requires an interdisciplinary approach for the evolution of the patient. Until now, there is no consensus on the management of chronic low back pain, which generated the concern of this systematic review. Aim: To identify the effectiveness of physiotherapy protocols in the management of chronic low back pain. Methodology: A systematic search was carried out in the Pubmed, ScienceDirect, Scopus, Oxford, Wiley, Cochrane Library Plus, PEDro, Epistemonikos, Hinari and LILACS, Google Scholar, Teseo and PROSPERO databases, from the beginning of the databases until August, 2021. The selection criteria were defined according to the intervention and topic of the article. Results: Twenty-six studies were included in the qualitative synthesis, articles that did not meet the inclusion criteria were excluded. An effect was found in the control of pain and the reduction of disability and the main interventions are: muscular strengthening of the core and lower limbs, stretching of the lower limbs, lumbopelvic mobility and education or back school. The treatment frequency ranged from 2 to 3 times per week for 5 weeks. Conclusions: Greater effectiveness was found in pain control time and disability reduction, mainly related to core muscle strengthening and educational strategies.(AU)

Neuromuscular Control and Resistance Training for People With Chronic Low Back Pain: A Randomized Controlled Trial.

OBJECTIVE: To determine if adding lumbar neuromuscular control retraining exercises to a 12-week program of strengthening exercises had greater effect for improving disability than 12 weeks of strengthening exercises alone in people with chronic low back pain (LBP). DESIGN: Single-center, participant- and assessor-blinded, comparative effectiveness randomized controlled trial. METHODS: Sixty-nine participants (31 females; 29 males; mean age: 46.5 years) with nonspecific chronic LBP were recruited for a 12-week program involving lumbar extension neuromuscular retraining in addition to resistance exercises (intervention) or 12 weeks of resistance exercises alone (control). The primary outcome measure was the Oswestry Disability Index. Secondary outcome measures included the Numeric Rating Scale, Tampa Scale for Kinesiophobia, Pain Self-Efficacy Questionnaire, and the International Physical Activity Questionnaire. Outcomes were measured at baseline, 6 weeks, and 12 weeks. RESULTS: Forty-three participants (22 control, 21 intervention) completed all outcome measures at 6 and 12 weeks. Fourteen participants were lost to follow-up, and 12 participants discontinued due to COVID-19 restrictions. Both groups demonstrated clinically important changes in disability, pain intensity, and kinesiophobia. The difference between groups with respect to disability was imprecise and not clinically meaningful (mean difference, -4.4; 95% CI: -10.2, 1.4) at 12 weeks. Differences in secondary outcomes at 6 or 12 weeks were also small with wide confidence intervals. CONCLUSIONS: Adding lumbar neuromuscular control retraining to a series of resistance exercises offered no additional benefit over resistance exercises alone over a 12-week period. J Orthop Sports Phys Ther 2024;54(5):1-10. Epub 18 March 2024. doi:10.2519/jospt.2024.12349.

Eficacia del ejercicio de alta intensidad en personas con dolor lumbar crónico: una revisión sistemática / Efficacy of high-intensity exercise in people with chronic low back pain: A systematic review

El dolor lumbar crónico causa discapacidad e impacto socioeconómico. El ejercicio de alta intensidad muestra resultados positivos en otras enfermedades, pero no existe evidencia sobre esta patología. Se pretende determinar su eficacia en la calidad de vida relacionada con la salud, la discapacidad, la intensidad del dolor y la adherencia al tratamiento en personas con dolor lumbar crónico. Se realiza una revisión bibliográfica en Pubmed, PEDro y Scopus, incluyendo ensayos clínicos aleatorizados, guías de práctica clínica y revisiones sistemáticas en español, inglés o portugués (2012-2022). Además, se hace una búsqueda en bola de nieve. Se incorporan ocho ensayos clínicos aleatorizados (n=379). Se analizan diferentes modalidades de ejercicio de alta intensidad, que parecen mejorar la calidad de vida relacionada con la salud y reducir la discapacidad y la intensidad del dolor. Estos datos se deben tomar con cautela dada la poca cantidad de estudios y el riesgo de sesgo que presentan.(AU)

Chronic low back pain causes disability and socioeconomic impact. High-intensity exercise shows positive results in other diseases, but there is no evidence on this pathology. The aim is to determine its efficacy on health-related quality of life, disability, pain intensity and adherence to treatment in people with chronic low back pain. A literature review is conducted in Pubmed, PEDro and Scopus, including randomized clinical trials, clinical practice guidelines and systematic reviews in Spanish, English or Portuguese (2012-2022). In addition, a snowball search is performed. Eight randomized clinical trials (n=379) are incorporated. Different high-intensity exercise modalities are analyzed, which seem to improve health-related quality of life and reduce disability and pain intensity. These data should be taken with caution given the small number of studies and the risk of bias presented.(AU)

Effectiveness of myofascial release for adults with chronic neck pain: a meta-analysis.

BACKGROUND: Every second human will experience a phase of neck pain in their lifetime and a high rate of chronicity exists. Because of the complexity and multiple influencing factors, chronic pain conditions are associated with a long treatment and diagnostic process. This leads to a prolonged healing process and high costs. OBJECTIVE: To evaluate the effect of myofascial release on the variables of pain and range of motion in patients with chronic neck pain. METHOD: Selection criteria were set to create a search algorithm for a systematic search in the databases: PubMed, Google Scholar, EBM Reviews, Medline, CINAHL, PEDro, and Science Direct. The risk of bias and the methodological quality was analyzed with the PEDro scale. RESULT: Ten randomized controlled trials, with 549 participants met the eligibility criteria. The methodological quality was ranked from good to excellent. The myofascial release showed a significant difference in pain (p =  0.03), rotation to the right (p =  0.05), and lateral flexion to the right (p =  0.04), compared to other treatment methods. No significant effect was found for improvements in pressure pain threshold. CONCLUSION: Modest effects are observed in pain reduction, suggesting potential benefits of myofascial release in managing chronic neck pain. Further research with standardized protocols and direct comparisons to established therapies is crucial for a comprehensive understanding of myofascial release efficacy. CONTRIBUTION OF THE PAPER: What does the meta-analysis add to the current literature.

The effects of virtual reality training on postural sway and physical function performance on older women with chronic low back pain: A double-blind randomized clinical trial.

BACKGROUND: Chronic low back pain (CLBP) is known as an important debilitating health condition among older women. OBJECTIVE: This study aimed to evaluate the effects of eight-week virtual reality training (VRT) exercises on postural sway and physical function performance (PFP) among older women suffering from CLBP. METHODS: Twenty-seven older women presenting with CLBP were randomized into experimental and control groups. The experimental group was instructed to perform 30-minute VRT exercises three times a week for eight weeks. Plantar pressure variables [sway velocity (SV) and anterior-posterior (AP) and medial-lateral (ML) fluctuations of the center of pressure (CoP)], 30-second chair stand test (30CST), and timed up and go (TUG) test were recorded. RESULTS: The VRT group exhibited significant decreases in SV (p= 0.002), AP (p= 0.008), and ML (p= 0.02) fluctuations. Also, the performance of the VRT group in the 30CST and TUG tests significantly improved after the exercises (P< 0.001). CONCLUSION: According to the results, VRT and the program used in this study should be used to enhance balance and PFP in older women with CLBP who mostly prefer activities that are accessible and feasible in low-risk environments.

Child appraisals of injustice in the context of acute and chronic pain: An interpretative phenomenological analysis.

BACKGROUND: Recent research has found child pain-related injustice appraisals to be associated with adverse pain-related outcomes. However, this evidence is mainly based on research using a measure developed for adults in the context of accident-related injuries, which may not translate to paediatric pain populations. Research on the phenomenology of child pain-related injustice appraisals is lacking. This study aimed to examine the phenomenology of pain-related injustice appraisals among both pain-free children and children living with chronic pain, to compare and contrast their experiences. METHODS: Two focus groups were held with pain-free children (n = 16), and three focus groups were held with paediatric chronic pain patients attending a rehabilitation centre (n = 15) in Belgium. Interpretative phenomenological analysis was applied. RESULTS: Two injustice-related themes were generated from the focus groups with pain-free children: (1) 'Someone else is at fault' and (2) 'I am in pain and he is not'. Two injustice-related themes were generated from the focus groups with paediatric chronic pain patients: (1) 'People don't see my pain' and (2) 'I am missing out because of my pain'. CONCLUSIONS: This study offers the first exploration of the phenomenology of child pain-related injustice appraisals in both pain-free children and paediatric pain patients. Findings highlight the interpersonal nature of lived injustice experiences caused by chronic pain, which is not fully captured by existing child pain-related injustice measures. Findings further suggest that pain-related injustice notions may not be extrapolated from a chronic to an acute pain context. SIGNIFICANCE: The current study offers the first exploration of the phenomenology of child pain-related injustice appraisals in both pain-free children and paediatric chronic pain patients. Findings highlight the interpersonal nature of injustice appraisals that are specific to the experience of chronic rather than acute pain. These appraisals are not fully captured by current child pain-related injustice measures.

A single session of action observation therapy versus observing a natural landscape in adults with chronic neck pain - a randomized controlled trial.

BACKGROUND: Action observation (AO) has emerged as a potential neurorehabilitation therapy for patients with neck pain (NP), but evidence of its effectiveness is scarce. This study aims to assess the effect of a single session of AO when compared to observing a natural landscape on NP intensity, fear of movement, fear-avoidance beliefs, neck muscles' strength, pressure pain threshold, and tactile acuity. METHODS: Sixty participants with NP were randomly allocated to the AO group (n = 30) or control group (n = 30). Both groups watched an 11-minute video: the AO group watched a video of a person matched for age and sex performing neck exercises, while the control group watched a video of natural landscapes. Neck pain intensity, fear of movement, fear-avoidance beliefs, tactile acuity, pressure pain thresholds, and neck muscle strength were assessed both at baseline and post-intervention. General linear models of repeated measures (ANCOVA of two factors) were used to explore between-group differences at post-intervention. RESULTS: There was a significant main effect of time for pain intensity (p = 0.02; η2p = 0.09; within-group mean change and 95% CI: AO=-1.44 (-2.28, -0.59); control=-1.90 (-2.74, -1.06), but no time versus group interaction (p = 0.46). A time versus group significant interaction was found for one out of the six measurement sites of two-point discrimination and the neck flexors strength (p < 0.05) favoring the control group. No other statistically significant differences were found for the remaining variables). CONCLUSIONS: Results suggest a similar acute benefit for both a single session of AO and observing natural landscapes for promoting hypoalgesia, but no impact on kinesiophobia, fear-avoidance beliefs, or pressure pain thresholds. Also, AO had no positive effect on two-point discrimination and muscle strength. Further research is needed, with longer interventions. TRIAL REGISTRATION: Clinialtrials.gov (NCT05078489).

Clarification of the "pain neuroscience education" concept in the management of patients with persistent low back pain: A scoping review.

BACKGROUND: Patient education is a recommended treatment strategy for persistent low back pain (PLBP). Pain neuroscience education (PNE) is an emerging concept with boundaries still unclear. OBJECTIVE: To clarify the PNE concept and identify its key characteristics in PLBP management. METHODS: A systematic search was conducted using the following databases: Pubmed, ScienceDirect, Google Scholar, Cochrane, and Pedro. INCLUSION CRITERIA: publications in English or French on pain neuroscience education and chronic low back pain, educational books cited in white literature. Three reviewers independently selected eligible studies for final inclusion. Numerical analysis and narrative synthesis were carried out from the extracted data. RESULTS: From 919 identified publications, 54 were selected. Ten educational resources were added. PNE refers to a theoretical framework, a specific educational intervention, and an overall care approach. It is characterized by the intention to help the patient reconceptualize their PLBP from a tissue injury marker to a protective, neurobiological perspective, and then to increase adherence to biopsychosocial rehabilitation and normalize cognitive-behavioral responses. Pain sciences concepts are presented with an optimization of learning strategies. CONCLUSION: PNE stands out from other educational and cognitive behavioral approaches through its objective of changing the pain concept.

A randomized controlled trial on the effects of "Global Postural Re-education" versus neck specific exercise on pain, disability, postural control, and neuromuscular features in women with chronic non-specific neck pain.

BACKGROUND: Neck pain is associated with decreased health-related quality of life, decreased work productivity, and increased visits to health care providers. AIM: The aim of this study was to assess the effectiveness of "Global Postural Re-education" (GPR) versus a neck specific exercise (SE) program on neck pain, disability, cervical range of movement, postural stability, and activity of the superficial cervical flexor muscles. DESIGN: A parallel-group and single-blinded clinical trial. SETTING: Community interventions. POPULATION: Fifty women with non-specific chronic neck pain (NSCNP). METHODS: Participants were randomly assigned to one of the two intervention groups (GPR [N.=25] or SE [N.=25]). Both interventions consisted of eight sessions of ~40 minutes duration, performed twice a week, for four weeks. Outcomes included neck pain intensity and disability, cervical range of motion (CROM), postural sway, and activity of the superficial neck flexor muscles during a cranio-cervical flexion test (CCFT). All outcomes were assessed twice before the intervention and immediately following eight treatment sessions over four weeks. RESULTS: Both interventions were equally effective in reducing neck pain (P<0.001, ŋp2=0.770) and disability (P<0.001, ŋp2=0.306), improving neck mobility (P<0.001, 0.385≤ŋp2≤0.623, for all measurements) and decreasing the activity of the superficial cervical flexor muscles (P>0.001). Neither intervention altered postural sway. CONCLUSIONS: Our results revealed that GPR and SE induced significant positive results in all measures apart from postural stability but with no difference between the interventions. CLINICAL REHABILITATION IMPACT: "Global Postural Re-education" (GPR) and neck SE interventions are equally effective in reducing neck pain and disability, and improving neck mobility in women with NSCNP. Overall, this study indicates that GPR and SE interventions can be used to effectively manage patients with NSCNP.

Components of primary care multimodal rehabilitation and their association with changes in sick leave: An observational study.

BACKGROUND: To address the increase in sick leave for nonspecific chronic pain and mental illness, the Swedish government and the Swedish Association of Local Authorities and Regions entered into an agreement on a "Rehabilitation Guarantee" to carry out multimodal rehabilitation (MMR). OBJECTIVE: To investigate whether components of primary care MMR are associated with changes in sick leave. METHODS: A web-based survey was conducted in conjunction with a retrospective cross-sectional observational study of 53 MMR units. Sick leave data for the years before and after MMR completion was collected for 846 individuals. RESULTS: There was great disparity in how MMR was delivered. The average duration of rehabilitation was 4-8 weeks, and 74% of the MMR teams reported having fewer patients than recommended (≥20/year). Only 58% of the teams met the competence requirements. In-depth competence in pain relief and rehabilitation was reported by 45% of the teams and was significantly associated with fewer sick leave days after MMR (26.53, 95% CI: 3.65; 49.42), as were pain duration (17.83, 95% CI: -9.20; 44.87) and geographic proximity (23.75, 95% CI: -5.25; 52.75) of the health care professionals included in the MMR unit. CONCLUSIONS: In-depth competence and knowledge about the complex health care needs of patients seem essential to MMR teams' success in reducing sickness benefits for patients with nonspecific chronic pain and mental illness. Further research is needed to elucidate the optimal combination of primary care MMR components for increasing the return-to work rate and to determine whether involvement of the Social Insurance Agency or employers could support and further contribute to recuperation and help patients regain their previous work capacity.

Pediatric pain rehabilitation during the COVID-19 pandemic: exploring the effectiveness of a hybrid intensive interdisciplinary pain treatment model.

PURPOSE: This study aimed to (1) examine improvements in rehabilitation outcomes after participation in a pediatric hybrid intensive interdisciplinary pain treatment model (50% in-person and 50% video-based telehealth) and (2) compare magnitude of hybrid model improvements to patients treated in a traditional, 100% in-person model prior to the pandemic. MATERIALS AND METHODS: Rehabilitation outcomes for 33 youth with chronic pain from the model were compared to 33 youth with chronic pain who completed a traditional, in-person model. Improvements between admission and discharge in both models were examined using paired student t-tests. Independent samples t-tests compared change scores for the hybrid and traditional models. RESULTS: Participants in both models experienced significant improvements on all rehabilitation outcomes, including cardiovascular endurance, pain interference, functional disability, and occupational performance (p < 0.001), except for pain intensity (p = 0.15). Change scores for rehabilitation outcomes did not significantly differ between models. CONCLUSIONS: Quantitatively, hybrid model rehabilitation outcomes appeared clinically equivalent to the traditional, in-person model. Qualitative and psychosocial outcome comparisons of each model are warranted to better understand challenges and barriers associated with hybrid pain treatment models. The feasibility and impact of tools to enhance telehealth, such as actigraphy or virtual reality, should also be explored.IMPLICATIONS FOR REHABILITATIONThis study supports the efficacy of video-based telehealth interventions for children and adolescents with chronic pain syndromes.Disability outcomes for a hybrid (50% in-person, 50% video-based telehealth) intensive interdisciplinary pain treatment program appear to be equivalent to patients treated within a fully in-person program.

Healthcare professionals' experiences and perspectives of team-based interdisciplinary pain rehabilitation with immigrants requiring an interpreter. A qualitative study.

PURPOSE: There is a lack of knowledge about interprofessional rehabilitation for culturally diverse patients with chronic pain. This study explores experiences of healthcare professionals developing and working with rehabilitation with patients in need of an interpreter and their experience of working with interpreters. METHODS: Twelve healthcare professionals at two Swedish specialist rehabilitation centres were interviewed. Grounded theory principles were used for the data collection and analysis. RESULTS: The main category "Demanding and Meaningful Work" represents three concurrently interacting categories: "Frustration" includes the informants' doubts regarding the benefits of the rehabilitation, lack of care for patients and cultural dissonance between professionals and patients. "Challenges" describes problems in the rehabilitation work due to the need for interpreted mediated communication, the complexity in health status and social aspects among the patients. "Solutions" represents practical working methods and personal approaches developed by the informants for managing frustrations and challenges. CONCLUSIONS: The informants' frustration and challenges when working with a new group of patients, vulnerable and different in their preconceptions, led to new solutions in working methods and approaches. When starting a pain rehabilitation programme for culturally diverse patients, it is important to consider the rehabilitation team's need for additional time and support.IMPLICATIONS FOR REHABILITATIONHealthcare professionals who encounter immigrants with chronic pain need resources to develop their own skills in order to handle complex ethical questions as the patients represent a vulnerable patient group with many low status identitiesIn order to adapt rehabilitation programmes to patient groups with different languages and pre-understandings of chronic pain, there is a need for a team with specific qualities, i.e., close cooperation, an innovative atmosphere, time and also support from expertsFor appropriate language interpretation it is important to have a professional interpreter and a healthcare professional who are aware of and adopt the rules, possibilities and restrictions of interpretationThe rehabilitation of patients in need of language interpretation needs more time and organisation compared to the rehabilitation of patients who speak the national language.

Sex and Age Group Focus on Outcomes after Multimodal Rehabilitation for Patients with Chronic Pain in Northern Sweden.

OBJECTIVES: To investigate the outcomes of a multimodal rehabilitation programme (MMRP) regarding pain intensity, emotional functioning, activity and physical functioning, social response, and health, with regard to sex and age. METHODS: This retrospective longitudinal study was based on data from patients at 2 specialist pain clinics in northern Sweden immediately after MMRP (short-term) and at 1-year follow-up (long-term). Data from 439 patients were analysed according to sex and to age groups 18-30, 31-45 and 46-65 years. RESULTS: The men improved with larger effect sizes (ESs) than women immediately after MMRP. The youngest age group showed improvements with greater ESs compared with the older age groups, both in the short and long term. Social support decreased for both women and men and in all 3 age groups in the long term. Improvements in both the short and long term were found in pain intensity, emotional functioning, and activity and physical functioning, in both women and men, as well as the different age groups. CONCLUSION: Both women and men with chronic pain, and from all of the different age groups, benefitted from MRRP. Since improvements for men were not sustained over time, they may need further support after the programme.

Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients With Chronic Low Back Pain: A Randomized Clinical Trial.

Importance: The effects of altered neural processing, defined as altering neural networks responsible for perceptions of pain and function, on chronic pain remains unclear. Objective: To estimate the effect of a graded sensorimotor retraining intervention (RESOLVE) on pain intensity in people with chronic low back pain. Design, Setting, and Participants: This parallel, 2-group, randomized clinical trial recruited participants with chronic (>3 months) nonspecific low back pain from primary care and community settings. A total of 276 adults were randomized (in a 1:1 ratio) to the intervention or sham procedure and attention control groups delivered by clinicians at a medical research institute in Sydney, Australia. The first participant was randomized on December 10, 2015, and the last was randomized on July 25, 2019. Follow-up was completed on February 3, 2020. Interventions: Participants randomized to the intervention group (n = 138) were asked to participate in 12 weekly clinical sessions and home training designed to educate them about and assist them with movement and physical activity while experiencing lower back pain. Participants randomized to the control group (n = 138) were asked to participate in 12 weekly clinical sessions and home training that required similar time as the intervention but did not focus on education, movement, and physical activity. The control group included sham laser and shortwave diathermy applied to the back and sham noninvasive brain stimulation. Main Outcomes and Measures: The primary outcome was pain intensity at 18 weeks, measured on an 11-point numerical rating scale (range, 0 [no pain] to 10 [worst pain imaginable]) for which the between-group minimum clinically important difference is 1.0 point. Results: Among 276 randomized patients (mean [SD] age, 46 [14.3] years; 138 [50%] women), 261 (95%) completed follow-up at 18 weeks. The mean pain intensity was 5.6 at baseline and 3.1 at 18 weeks in the intervention group and 5.8 at baseline and 4.0 at 18 weeks in the control group, with an estimated between-group mean difference at 18 weeks of -1.0 point ([95% CI, -1.5 to -0.4]; P = .001), favoring the intervention group. Conclusions and Relevance: In this randomized clinical trial conducted at a single center among patients with chronic low back pain, graded sensorimotor retraining, compared with a sham procedure and attention control, significantly improved pain intensity at 18 weeks. The improvements in pain intensity were small, and further research is needed to understand the generalizability of the findings. Trial Registration: ANZCTR Identifier: ACTRN12615000610538.

Outcomes of Telehealth Physical Therapy Provided Using Real-Time, Videoconferencing for Patients With Chronic Low Back Pain: A Longitudinal Observational Study.

OBJECTIVE: To describe the feasibility of an evidence-based physical therapy (PT) program for persons with chronic low back pain (LBP) originally designed for in-person delivery, adapted for telehealth using videoconferencing. DESIGN: Prospective, longitudinal cohort. SETTING: Three health care systems in the United States. PARTICIPANTS: Adults, aged 18-64 years (N=126), with chronic LBP recruited from August through December 2020. INTERVENTION: Up to 8 weekly sessions of telehealth PT. MAIN OUTCOME MEASURES: Follow-up assessments were 10 and 26 weeks after baseline. Participant outcomes collected were the Oswestry Disability Index, Patient-Reported Outcomes Measurement Information System-29 health domains, and pain self-efficacy. Implementation outcomes included acceptability, adoption, feasibility, and fidelity assessed using participant surveys and compliance with session attendance. RESULTS: We enrolled 126 participants (mean age, 51.5 years; 62.7% female). Baseline perceptions about telehealth were generally positive. Eighty-eight participants (69.8%) initiated telehealth PT, with a median of 5 sessions attended. Participants in telehealth PT were generally satisfied (76.3%), although only 39.5% perceived the quality equal to in-person PT. Telehealth PT participants reported significant improvement in LBP-related disability, pain intensity, pain interference, physical function, and sleep disturbance at 10- and 26-week follow-ups. CONCLUSIONS: The findings generally support the feasibility of telehealth PT using videoconferencing. Implementation and participant outcomes were similar to in-person PT as delivered in the participating health care systems. We identified barriers that may detract from the patient experience and likelihood of benefitting from telehealth PT. More research is needed to optimize and evaluate the most effective strategies for providing telehealth PT for patients with chronic LBP.

Profiles of Pain Acceptance and Values-Based Action in the Assessment and Treatment of Chronic Pain.

Pain acceptance and values-based action are relevant to treatment outcomes in those with chronic pain. It is unclear if patterns of responding in these 2 behavioral processes can be used to classify patients into distinct classes at treatment onset and used to predict treatment response. This observational cohort study had 2 distinct goals. First, it sought to classify patients at assessment based on pain acceptance and values-based action (N = 1746). Second, it sought to examine treatment outcomes based on class membership in a sub-set of patients completing an interdisciplinary pain rehabilitation program of Acceptance and Commitment Therapy for chronic pain (N = 343). Latent profile analysis was used in the larger sample to identify 3 distinct patient classes: low acceptance and values-based (AV) action (Low AV; n = 424), moderate acceptance and values-based action (Moderate AV; n = 983) and high acceptance and values-based action (High AV; n = 339). In the smaller treated sample, participants in the Low AV and Moderate AV class demonstrated improvements across all outcome variables, whereas those in the High AV class did not. These findings support the role of pain acceptance and values-based action in those with chronic pain. PERSPECTIVE: Individuals with chronic pain can be classified with respect to pain acceptance and values-based action and these groups may respond differently to treatment.

Catastrophizing as a prognostic factor for pain and physical function in the multidisciplinary rehabilitation of fibromyalgia and low back pain.

BACKGROUND: Quantitative data on longitudinal associations between catastrophizing and pain or physical function are patchy. The study aimed to quantify the prognostic value of catastrophizing for pain and function in fibromyalgia and low back pain before and after rehabilitation. METHODS: The associations of state and change on the Multidimensional Pain Inventory (MPI) Pain severity scale, the Short Form 36 (SF-36) Physical functioning scale and the Six-Minute Walking Distance (6MWD) with the Coping Strategies Questionnaire (CSQ) Catastrophizing scale were quantified by multiple regression modelling to adjust for confounders. RESULTS: Sex- and age-matched cohorts (n = 71 each) were compared. Pain and catastrophizing were worse in fibromyalgia than in low back pain, whereas the function levels were comparable. Baseline catastrophizing predicted pain change by adjusted correlations of 0.552 (fibromyalgia) and 0.450 (low back pain), self-rated function by 0.403 and 0.308, and the 6MWD by 0.270 and - 0.072. The change in catastrophizing was associated to the change in pain by 0.440 (fibromyalgia) and 0.614 (low back pain), self-rated function by 0.122 and 0.465, and the 6MWD by 0186 and 0.162. CONCLUSIONS: Catastrophizing (pain-related worrying) was a potential prognostic factor, especially for pain and somewhat less for self-rated physical function but it was only weakly predictive for the walking distance in both conditions, independently of potential confounders, such as sex, age, baseline severity and others. Reduction of maladaptive coping should be integrated into the management of chronic pain. SIGNIFICANCE: Our study showed surprisingly high associations between state and change in catastrophizing to pain relief and functional improvement in chronic pain patients. This is supported by clinical experience and research data, even if the construct and measurement of catastrophizing is under debate. Our findings and those of literature point to more pessimistic self-rating of pain and catastrophizing in fibromyalgia when compared to other conditions. This might obscure positive effects on pain and function achieved by adaptive coping in fibromyalgia.

Therapeutic Yoga for the Management of Chronic Nonspecific Neck Pain: Current Evidence and Mechanisms.

Chronic nonspecific neck pain (CNNP), which is neck pain in the absence of attributable structural and neurological findings, is often challenging for medical and rehabilitation professionals to treat. Conventional treatments such as medications and physical therapy often fail to provide lasting relief, which leads patients to pursue complementary therapies such as yoga. This review discusses the evidence from nine studies, including four randomized controlled trials, which suggests that a supervised yoga program may decrease pain intensity, disability, and mood symptoms in adults with CNNP. Cervical range of motion and quality of life (both physical and mental) may also improve with yoga intervention, although this is less consistent across studies. Evidence of yoga's superiority to other exercise-based practices such as pilates was conflicting. Adverse effects of yoga, such as exacerbation of neck pain, were relatively uncommon, minor, and often transient. This article also comprehensively reviews the pathophysiology of CNNP, therapeutic mechanisms of yoga, and limitations in the evidence (including risk-of-bias assessment). Future studies should attempt to: (1) compare the effectiveness of different lineages of yoga for individuals with CNNP, (2) determine the optimal length and duration of these yoga interventions, (3) better characterize the physical and psychological mechanisms of yoga, (4) compare yoga to other exercise- and mindfulness-based practices, (5) evaluate the effect of yoga on sleep in the CNNP population, and (6) explore the applicability/efficacy of virtual yoga instruction.