Multidimensional Recovery Trajectories Following Physiotherapy with or Without Pain Education in People with Chronic Low Back Pain

TL;DR

This study found that adding pain education to physiotherapy leads to better overall recovery for people with chronic low back pain compared to physiotherapy alone.

Contribution

The study identifies distinct recovery trajectories and shows that pain education significantly improves multidimensional recovery in chronic low back pain patients.

Findings

Three recovery trajectories were identified: minimal recovery, psychosocial-dominant recovery, and global recovery.

Physiotherapy with pain education resulted in more global recovery compared to physiotherapy alone.

Psychosocial-dominant recovery showed significant improvements in psychological well-being and self-efficacy.

Abstract

Background/Objective: To investigate short-term multidimensional recovery trajectories after physiotherapy with or without adjunctive pain education in individuals with Chronic low back pain (CLBP). Methods: This was a secondary analysis of a randomized controlled trial (RCT) of 92 participants (46 participants per group) comparing physiotherapy alone with physiotherapy plus pain education. Changes from baseline values over six weeks were calculated for pain intensity, disability, psychological well-being, and self-efficacy to define short-term recovery trajectories across domains, and were standardized prior to analysis. Descriptive characterization of recovery dimensions by principal component analysis and identification of different recovery trajectory clusters by k-means clustering were performed. Sensitivity analyses with multinomial logistic regression were performed to determine robustness after adjustment for baseline characteristics. Results: Three recovery trajectories were found: minimal recovery (n = 40), psychosocial-dominant recovery (n = 26), and global recovery (n = 26). In the physiotherapy-only group, participants were classified as minimal recovery (61%) or psychosocial-dominant recovery (39%), with no cases of global recovery. In contradistinction, 57% of participants receiving physiotherapy with pain education were classified as within the global recovery trajectory, with fewer classified as minimal recovery (26%) or psychosocial-dominant recovery (17%). Psychosocial-dominant recovery occurred in both groups, and was characterized by large improvements in psychological well-being and self-efficacy with more modest changes in pain and disability. The distribution of recovery trajectories between treatment groups was large (χ2(2)= 36.25, p < 0.001; Cramer’s V = 0.63). Conclusions: Distinct short-term recovery trajectories were found after physiotherapy with or without pain education in individuals with CLBP, reflecting heterogeneity in multidimensional recovery that is not reflected in mean-based outcome analyses.

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