A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain (NCT00373867)

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

doi:10.1016/j.pain.2008.07.029

Cited by 134Musculoskeletal pain and rehabilitationPain Management and TreatmentMedical Practices and Rehabilitation

A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain (NCT00373867)

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George, Steven Z., Zeppieri, Giorgio, Cere, Anthony L., Cere, Melissa R., Borut, Michael S., Hodges, Michael J., Reed, Dalton M., Valencia, Carolina +1 more·2008·Pain

DOI 10.1016/j.pain.2008.07.029PMC PMC2596955

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Abstract

Psychological factors consistent with fear-avoidance models are associated with the development of chronic low back pain (LBP). As a result, graded activity (GA) and graded exposure (GX) have been suggested as behavioral treatment options. This clinical trial compared the effectiveness of treatment-based classification (TBC) physical therapy alone to TBC augmented with GA or GX for patients with acute and sub-acute LBP. Our primary hypothesis was that GX would be most effective for those with elevated pain-related fear. In total, 108 patients enrolled in this clinical trial and were randomly assigned to receive TBC, GA, or GX. Outcomes were assessed by a blinded evaluator at 4 weeks and by mail at 6 months. The primary outcomes for this trial were disability and pain intensity, and the secondary outcomes were fear-avoidance beliefs, pain catastrophizing, and physical impairment. 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 TBC with GA or GX was not effective for improving important outcomes related to the development of chronic LBP.

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Prior RCTs of GET in adults utilized monodisciplinary treatment controls of CBT, Graded Activity, PT, or manual therapy, in contrast to a multidisciplinary treatment control.
“we identified that prior RCTs utilized monodiscliplinary treatment controls of CBT[49], Graded Activity[73], PT[16], or manual therapy[1], in contrast to a multidisciplinary treatment control.”
From A randomized controlled trial of graded exposure treatment (GET living) for adolescents with chronic pain (2024) · cites this paper as [16]

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Authors: George, S. Z., Zeppieri, G., Cere, A. L., Cere, M. R., Borut, M. S., Hodges, M. J., Reed, D. M., Valencia, C., & Robinson, M. E.
Affiliations: University of Florida (US)
University of Florida Health (US)
Corresponding author: George, Steven Z.
ORCID: George, Steven Z.
Zeppieri, Giorgio
Valencia, Carolina
Robinson, Michael E.
Venue: Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2008-11-15
Volume: 140
Issue: 1
Pages: 145-157
ISSN: 0304-3959 (ISSN-L)
DOI: 10.1016/j.pain.2008.07.029
PMC: PMC2596955
OpenAlex: W1984753997
Cited by: 134
References: 56
Citations by year: 2026: 1 · 2025: 5 · 2024: 3 · 2023: 6 · 2022: 4 · 2021: 4 · 2020: 4 · 2019: 7 · 2018: 10 · 2017: 10 · 2016: 5 · 2015: 7 · 2014: 8 · 2013: 13 · 2012: 11
FWCI: 8.41
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Pain (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Arthritis and Musculoskeletal and Skin Diseases (AR051128, R03AR051128)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords: low back pain, acute low back pain, subacute low back pain, graded activity, graded exposure, fear-avoidance beliefs, pain catastrophizing, disability, pain intensity, physical impairment
MeSH terms: Acute Disease, Adult, Behavior Therapy, Female, Humans, Male, Pain Measurement, Treatment Outcome, Low Back Pain, Physical Therapy Specialty

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A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain (NCT00373867)

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