A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain

Steven Z. George, Giorgio Zeppieri Jr., Anthony L. Cere, Melissa R. Cere, Michael S. Borut, Michael J. Hodges, Dalton M. Reed, Carolina Valencia, Michael E. Robinson

This clinical trial compared the effectiveness of treatment-based classification (TBC) physical therapy alone to TBC augmented with graded activity (GA) and graded exposure (GX) for patients with acute and sub-acute LBP. 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 treatment-based classification with graded activity and graded exposure was not effective for improving important outcomes related to the development of chronic LBP.

Pain, 10 September 2008, online article ahead of print

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