Physiotherapy informed by acceptance and commitment therapy for chronic low back pain: A randomized trial

Area of Science:

• Pain Management
• Behavioral Psychology
• Physical Therapy

Background:

• Chronic low back pain (CLBP) is a global health issue, often managed with a biopsychosocial approach.
• Psychological factors like motivation significantly impact CLBP treatment outcomes.
• Acceptance and Commitment Therapy (ACT) integrated into physiotherapy (PACT) shows promise for chronic pain.

Purpose of the Study:

• To evaluate exercise motivation in PACT versus usual physiotherapy care (UC) for CLBP.
• To compare the efficacy of PACT and UC on functioning, disability, exercise adherence, pain acceptance, and autonomy support.
• To assess the impact of dynamic neuromuscular stabilization (DNS)-based graded exercise within both interventions.

Main Methods:

• Fifty CLBP patients were randomized into PACT or UC groups.
• Both groups received DNS-based graded exercise; PACT included ACT principles.
• Data collected via self-reported questionnaires at baseline and 6 weeks post-intervention.

Main Results:

• PACT significantly increased exercise motivation (introjected, identified, intrinsic) and perceived autonomy support compared to UC.
• PACT group demonstrated significantly greater adherence to physical activity.
• Both groups improved functioning and pain acceptance, with no significant between-group differences in these outcomes.

Conclusions:

• PACT, combined with DNS-based exercise, enhances motivation, autonomy support, and adherence in CLBP patients.
• Integrating ACT into physiotherapy may improve motivational outcomes and physical activity engagement for CLBP.
• Further research with larger samples and longer follow-up is recommended to confirm these findings.