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

Marketa Nevelikova1,2, Filip Zlamal3, Filip Dosbaba2,4,5,6

  • 1Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University, University Hospital Motol, Prague, Czech Republic.

Hong Kong Physiotherapy Journal : Official Publication of the Hong Kong Physiotherapy Association Limited = Wu Li Chih Liao
|April 22, 2026
PubMed
Summary

Physiotherapy-informed Acceptance and Commitment Therapy (PACT) significantly improved exercise motivation and adherence in chronic low back pain (CLBP) patients compared to usual care. PACT enhances psychological flexibility and values-based action, crucial for managing CLBP effectively.

Keywords:
Acceptance and commitment therapychronic low back painexercise motivationphysiotherapy adherenceself-determination theory

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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.