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Which Chronic Low Back Pain Patients Respond Favorably to Yoga, Physical Therapy, and a Self-care Book? Responder Analyses from a Randomized Controlled Trial.

Authors
  • Roseen, Eric J1, 2
  • Gerlovin, Hanna3
  • Felson, David T4
  • Delitto, Anthony5
  • Sherman, Karen J6, 7
  • Saper, Robert B1
  • 1 Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA.
  • 2 Department of Rehabilitation Science, Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts, USA.
  • 3 Slone Epidemiology Center, Boston University School of Medicine, Boston, Massachusetts, USA.
  • 4 Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
  • 5 School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
  • 6 Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.
  • 7 Department of Epidemiology, University of Washington, Seattle, Washington, USA.
Type
Published Article
Journal
Pain medicine (Malden, Mass.)
Publication Date
Feb 04, 2021
Volume
22
Issue
1
Pages
165–180
Identifiers
DOI: 10.1093/pm/pnaa153
PMID: 32662833
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To identify baseline characteristics of adults with chronic low back pain (cLBP) that predict response (i.e., a clinically important improvement) and/or modify treatment effect across three nonpharmacologic interventions. Secondary analysis of a randomized controlled trial. Academic safety net hospital and seven federally qualified community health centers. Adults with cLBP (N = 299). We report patient characteristics that were predictors of response and/or modified treatment effect across three 12-week treatments: yoga, physical therapy [PT], and a self-care book. Using preselected characteristics, we used logistic regression to identify predictors of "response," defined as a ≥30% improvement in the Roland Morris Disability Questionnaire. Then, using "response" as our outcome, we identified baseline characteristics that were treatment effect modifiers by testing for statistical interaction (P < 0.05) across two comparisons: 1) yoga-or-PT vs self-care and 2) yoga vs PT. Overall, 39% (116/299) of participants were responders, with more responders in the yoga-or-PT group (42%) than the self-care (23%) group. There was no difference in proportion responding to yoga (48%) vs PT (37%, odds ratio [OR] = 1.5, 95% confidence interval = 0.88 - 2.6). Predictors of response included having more than a high school education, a higher income, employment, few depressive symptoms, lower perceived stress, few work-related fear avoidance beliefs, high pain self-efficacy, and being a nonsmoker. Effect modifiers included use of pain medication and fear avoidance beliefs related to physical activity (both P = 0.02 for interaction). When comparing yoga or PT with self-care, a greater proportion were responders among those using pain meds (OR = 5.3), which differed from those not taking pain meds (OR = 0.94) at baseline. We also found greater treatment response among those with lower (OR = 7.0), but not high (OR = 1.3), fear avoidance beliefs around physical activity. Our findings revealed important subgroups for whom referral to yoga or PT may improve cLBP outcomes. © The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected]

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