瑜伽、物理治疗和教育治疗慢性下背痛的随机对照试验中疼痛自我效能感、应对技能和恐惧回避信念的变化。
Changes in Pain Self-Efficacy, Coping Skills, and Fear-Avoidance Beliefs in a Randomized Controlled Trial of Yoga, Physical Therapy, and Education for Chronic Low Back Pain.
机构信息
Tufts University School of Medicine, Boston, Massachusetts.
Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts.
出版信息
Pain Med. 2022 Apr 8;23(4):834-843. doi: 10.1093/pm/pnab318.
OBJECTIVE
We evaluated exercise interventions for cognitive appraisal of chronic low back pain (cLBP) in an underserved population.
METHODS
We conducted a secondary analysis of the Back to Health Trial, showing yoga to be noninferior to physical therapy (PT) for pain and function outcomes among adults with cLBP (n = 320) recruited from primary care clinics with predominantly low-income patients. Participants were randomized to 12 weeks of yoga, PT, or education. Cognitive appraisal was assessed with the Pain Self-Efficacy Questionnaire (PSEQ), Coping Strategies Questionnaire (CSQ), and Fear-Avoidance Beliefs Questionnaire (FABQ). Using multiple imputation and linear regression, we estimated within- and between-group changes in cognitive appraisal at 12 and 52 weeks, with baseline and the education group as references.
RESULTS
Participants (mean age = 46 years) were majority female (64%) and majority Black (57%), and 54% had an annual household income <$30,000. All three groups showed improvements in PSEQ (range 0-60) at 12 weeks (yoga, mean difference [MD] = 7.0, 95% confidence interval [CI]: 4.9, 9.0; PT, MD = 6.9, 95% CI: 4.7 to 9.1; and education, MD = 3.4, 95% CI: 0.54 to 6.3), with yoga and PT improvements being clinically meaningful. At 12 weeks, improvements in catastrophizing (CSQ, range 0-36) were largest in the yoga and PT groups (MD = -3.0, 95% CI: -4.4 to -1.6; MD = -2.7, 95% CI: -4.2 to -1.2, respectively). Changes in FABQ were small. No statistically significant between-group differences were observed on PSEQ, CSQ, or FABQ at either time point. Many of the changes observed at 12 weeks were sustained at 52 weeks.
CONCLUSION
All three interventions were associated with improvements in self-efficacy and catastrophizing among low-income, racially diverse adults with cLBP.
TRIAL REGISTRATION
ClinicalTrials.gov identifier NCT01343927.
目的
我们评估了针对服务不足人群慢性下背痛（cLBP）认知评估的运动干预措施。
方法
我们对 Back to Health 试验进行了二次分析，该试验显示瑜伽在疼痛和功能结局方面不劣于物理治疗（PT），纳入的参与者为初级保健诊所中收入较低的成年人（n=320），他们患有 cLBP。参与者被随机分配到 12 周的瑜伽、PT 或教育组。使用疼痛自我效能问卷（PSEQ）、应对策略问卷（CSQ）和恐惧回避信念问卷（FABQ）评估认知评估。使用多重插补和线性回归，我们估计了 12 周和 52 周时认知评估的组内和组间变化，以基线和教育组作为参考。
结果
参与者（平均年龄 46 岁）主要为女性（64%）和黑人（57%），54%的人家庭年收入<30000 美元。所有三组在 12 周时 PSEQ（范围 0-60）均有改善（瑜伽，平均差异 [MD] = 7.0，95%置信区间 [CI]：4.9，9.0；PT，MD = 6.9，95% CI：4.7 至 9.1；教育，MD = 3.4，95% CI：0.54 至 6.3），瑜伽和 PT 的改善具有临床意义。在 12 周时，瑜伽和 PT 组的灾难化（CSQ，范围 0-36）改善最大（MD = -3.0，95% CI：-4.4 至-1.6；MD = -2.7，95% CI：-4.2 至-1.2）。FABQ 的变化很小。在任何时间点，PSEQ、CSQ 或 FABQ 均未观察到组间统计学上的显著差异。在 12 周时观察到的许多变化在 52 周时仍然存在。
结论
所有三种干预措施都与低收入、种族多样化的慢性下背痛成年人的自我效能和灾难化改善相关。
试验注册
ClinicalTrials.gov 标识符 NCT01343927。
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