In:
Pain Medicine, Oxford University Press (OUP), Vol. 22, No. 1 ( 2021-02-04), p. 165-180
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. 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 & lt; 0.05) across two comparisons: 1) yoga-or-PT vs self-care and 2) yoga vs PT. 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.
Type of Medium:
Online Resource
ISSN:
1526-2375
,
1526-4637
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2021
detail.hit.zdb_id:
2023869-1
