Positive Health Online

Abstract

DAY and COLLEAGUES, (1)School of Psychology, University of Queensland, 330 McElwain Building, Brisbane, QLD, 4072, Australia. m.day@uq.edu.au .(2) Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA. m.day@uq.edu.au .(3) Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; (4) Departments of Psychiatry, Anesthesia, and Stomatology, Medical University of South Carolina, Charleston, SC, USA; (5) Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.; (6)Department of Psychology, University of Alabama, Tuscaloosa, AL, USA conducted a study which aimed to evaluate the relative immediate (pre- to post-treatment) and longer term (pre-treatment to 3- and 6-month follow-ups) effects of group, videoconference-delivered of 3 treatments cognitive therapy (CT), behavioral activation (BA), and mindfulness meditation (MM) for Chronic low back pain  (CLBP).

Background

Chronic low back pain (CLBP) is a significant problem affecting millions of people worldwide. Three widely implemented psychological techniques used for CLBP management are cognitive therapy (CT), mindfulness meditation (MM), and behavioral activation (BA). This study aimed to evaluate the relative immediate (pre- to post-treatment) and longer term (pre-treatment to 3- and 6-month follow-ups) effects of group, videoconference-delivered CT, BA, and MM for CLBP.

Methodology

This is a secondary analysis of a three-arm, randomized clinical trial comparing the effects of three active treatments-CT, BA, and MM-with no inert control condition. Participants were N = 302 adults with CLBP, who were randomized to condition. The primary outcome was pain interference, and other secondary outcomes were also examined. The primary study end-point was post-treatment. Intent-to-treat analyses were undertaken for each time point, with the means of the changes in outcomes compared among the three groups using an analysis of variance (ANOVA). Effect sizes and confidence intervals are also reported.

Results

Medium-to-large effect size reductions in pain interference were found within BA, CT, and MM (ds from - .71 to - 1.00), with gains maintained at both follow-up time points. Effect sizes were generally small to medium for secondary outcomes for all three conditions (ds from - .20 to - .71). No significant between-group differences in means or changes in outcomes were found at any time point, except for change in sleep disturbance from pre- to post-treatment, improving more in BA than MM (d =  - .49).

Conclusion

The findings from this trial, one of the largest telehealth trials of psychological treatments to date, critically determined that group, videoconference-delivered CT, BA, and MM are effective for CLBP and can be implemented in clinical practice to improve treatment access. The pattern of results demonstrated similar improvements across treatments and outcome domains, with effect sizes consistent with those observed in prior research testing in-person delivered and multi-modal psychological pain treatments. Thus, internet treatment delivery represents a tool to scale up access to evidence-based chronic pain treatments and to overcome widespread disparities in healthcare. Conflict of interest statement: The authors declare that they have no competing interests. Trial Registration: Clinicaltrials.gov, NCT03687762. Erratum in  BMC Med. 22(1):447. doi: 10.1186/s12916-024-03693-5. Oct 9; 2024.

References

Day MA(1)(2), Ciol MA(3), Mendoza ME(3), Borckardt J(4), Ehde DM(3), Newman AK(3), Chan JF(3), Drever SA(3), Friedly JL(3), Burns J(5), Thorn BE(6), Jensen MP(3). The effects of telehealth-delivered mindfulness meditation, cognitive therapy, and behavioral activation for chronic low back pain: a randomized clinical trial.. BMC Med.22(1):156. doi: 10.1186/s12916-024-03383-2. Apr 12 2024.