Psychosocial Moderators and Mediators of Sensorimotor Exercise in Low Back Pain

A Randomized Multicenter Controlled Trial

Bibliographic Data

ID15523675
AuthorsPia‐maria Wippert (0000-0001-7221-4073, Brandenburg University of Technology Cottbus-Senftenberg, corresponding author), Daniel Niederer (0000-0002-7690-5418, Goethe University Frankfurt), David Drießlein (0000-0003-0311-9042, Ludwig-Maximilians-Universität München), Heidrun Beck (University Hospital Carl Gustav Carus), Winfried Banzer (Goethe University Frankfurt), Christian Schneider (0000-0001-9636-9766), Marcus Schiltenwolf (0000-0003-0835-4172, Heidelberg University), Frank Mayer (0000-0003-0101-2858, University of Potsdam)
Year2021
Volume12
Pages629474-629474
Publication date2021-07-29
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueFrontiers in Psychiatry (JOURNAL)
Journal identifiersISSN: 1664-0640 • E-ISSN: 1664-0640
PublisherFrontiers Media (PUBLISHER • CH)
DOI10.3389/fpsyt.2021.629474
PMID34393840
OpenAlexW3191879994
LanguageEN
References cited12

The effects of exercise interventions on unspecific chronic low back pain (CLBP) have been investigated in many studies, but the results are inconclusive regarding exercise types, efficiency, and sustainability. This may be because the influence of psychosocial factors on exercise induced adaptation regarding CLBP is neglected. Therefore, this study assessed psychosocial characteristics, which moderate and mediate the effects of sensorimotor exercise on LBP. A single-blind 3-arm multicenter randomized controlled trial was conducted for 12-weeks. Three exercise groups, sensorimotor exercise (SMT), sensorimotor and behavioral training (SMT-BT), and regular routines (CG) were randomly assigned to 662 volunteers. Primary outcomes (pain intensity and disability) and psychosocial characteristics were assessed at baseline (M1) and follow-up (3/6/12/24 weeks, M2-M5). Multiple regression models were used to analyze whether psychosocial characteristics are moderators of the relationship between exercise and pain, meaning that psychosocial factors and exercise interact. Causal mediation analysis were conducted to analyze, whether psychosocial characteristics mediate the exercise effect on pain. A total of 453 participants with intermittent pain (mean age = 39.5 ± 12.2 years, f = 62%) completed the training. It was shown, that depressive symptomatology (at M4, M5), vital exhaustion (at M4), and perceived social support (at M5) are significant moderators of the relationship between exercise and the reduction of pain intensity. Further depressive mood (at M4), social-satisfaction (at M4), and anxiety (at M5 SMT) significantly moderate the exercise effect on pain disability. The amount of moderation was of clinical relevance. In contrast, there were no psychosocial variables which mediated exercise effects on pain. In conclusion it was shown, that psychosocial variables can be moderators in the relationship between sensorimotor exercise induced adaptation on CLBP which may explain conflicting results in the past regarding the merit of exercise interventions in CLBP. Results suggest further an early identification of psychosocial risk factors by diagnostic tools, which may essential support the planning of personalized exercise therapy. Level of Evidence: Level I. Clinical Trial Registration: DRKS00004977, LOE: I, MiSpEx: grant-number: 080102A/11-14. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004977

Anxiety · Moderation · Mood · Physical medicine and rehabilitation · Physical therapy · Psychiatry · Psychological intervention · Psychosocial · Psychotherapist · Randomized controlled trial · Social support · Clinical Psychology · Fibromyalgia and Chronic Fatigue Syndrome Research · Medicine · Musculoskeletal pain and rehabilitation · Pain Mechanisms and Treatments · Psychology

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