Which Chronic Low Back Pain Patients Respond Favorably to Yoga, Physical Therapy, and a Self-care Book? Responder Analyses from a Randomized Controlled Trial
| Autor: | David T. Felson, Karen J. Sherman, Hanna Gerlovin, Robert B. Saper, Eric J. Roseen, Anthony Delitto |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Referral Rehabilitation & Regenerative Medicine Section Logistic regression law.invention Randomized controlled trial law Humans Medicine Physical Therapy Modalities business.industry Books Yoga General Medicine Odds ratio humanities Health equity Confidence interval Self Care Treatment Outcome Anesthesiology and Pain Medicine Roland Morris Disability Questionnaire Community health Physical therapy Neurology (clinical) business Low Back Pain |
| Zdroj: | Pain Med |
| ISSN: | 1526-4637 1526-2375 |
| DOI: | 10.1093/pm/pnaa153 |
| Popis: | Purpose 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. Design Secondary analysis of a randomized controlled trial. Setting Academic safety net hospital and seven federally qualified community health centers. Subjects Adults with cLBP (N = 299). Methods 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 Results 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. Conclusions Our findings revealed important subgroups for whom referral to yoga or PT may improve cLBP outcomes. |
| Databáze: | OpenAIRE |
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