Chronic Low Back Pain: Predictors of Response to Yoga, Physical Therapy Identified

New findings published in the journal Pain Medicine have shed light on predictors of treatment response to yoga, physical therapy, or a self-care book among patients with chronic low back pain.

These findings emerged from a study of interventions involving yoga, physical therapy, or a self-care book that lasted 12 weeks. Logistic regression using preselected characteristics was used to identify predictors of treatment “response,” which the researchers defined as an improvement of at least 30% in the Roland Morris Disability Questionnaire. Subsequently, “response” was used as the outcome of the study to identify baseline characteristics by testing for statistical interaction for yoga or physical therapy vs self-care, and for yoga vs physical therapy.

The results of the study indicated that 116 (39%) of 299 participants demonstrated a “response” to treatment. More participants in the group receiving yoga or physical therapy were responders to treatment (42%) compared with the self-care group (23%). The researchers observed no difference in the proportion of participants who responded to yoga (48%) vs physical therapy (37%, odds ratio [OR] 1.5).

The researchers found that higher income, having an education beyond high school, employment, lower perceived stress, few symptoms of depression, few work-related fear avoidance beliefs, not smoking, and high pain self-efficacy predicted “response” to treatment. They noted that pain medication and fear avoidance beliefs associated with physical activity were effect modifiers.

When the researchers compared yoga or physical therapy with self-care, they found that a greater proportion of participants who used pain medications (OR 5.3) responded to treatment compared with those who did not use pain medications at baseline (OR 0.94).

Greater treatment response was also observed among those with lower fear avoidance beliefs associated with physical activity (OR 7.0), but not high fear avoidance beliefs (OR 1.3).

—Christina Vogt

Reference:
Roseen EJ, Gerlovin H, Felson DT, Delitto A, Sherman KJ, Saper RB. Which chronic low back pain patients respond favorably to yoga, physical therapy, and a self-care book? Responder analyses from a randomized controlled trial. Pain Med. Published online July 14, 2020. doi:10.1093/pm/pnaa153