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A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain (NCT00373867)
Open accessAbstract
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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“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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Metadata
- 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.
- Venue
- Pain
- Published
- 2008-11-15
- Volume
- 140
- Issue
- 1
- Pages
- 145-157
- ISSN
- 0304-3959 (ISSN-L)
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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