Which Chronic Low Back Pain Patients Respond Favorably to Yoga, Physical Therapy, and a Self-care Book? Responder Analyses from a Randomized Controlled Trial. Issue 1 (14th July 2020)

• Record Type: Journal Article
• Authors: Roseen, Eric J; Gerlovin, Hanna; Felson, David T; Delitto, Anthony; Sherman, Karen J; Saper, Robert B
• Is Part Of: Pain medicine. Volume 22:Issue 1(2021)
• Page Start: 165
• Page End: 180
• Publication Date: 2020-07-14
• Subjects: Chronic Low Back Pain -- Yoga -- Physical Therapy -- Primary Care -- Predictor of Response -- Effect Modification -- Health Disparities; Pain -- Periodicals; Pain -- Treatment -- Periodicals; Analgesics -- Periodicals; Pain -- Periodicals; Pain Management -- Periodicals; Douleur -- Périodiques; Douleur -- Traitement -- Périodiques; Analgésiques -- Périodiques; Analgésique; Soulagement de la douleur; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.047205
• DOI: 10.1093/pm/pnaa153
• Languages: English
• ISSNs: 1526-2375

Abstract

Abstract: 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 < 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.