Authors (including presenting author) :
Lau SYJ(1), Yeung KCA(1), Siu HKE(1)
Affiliation :
(1) Physiotherapy Department, Prince of Wales Hospital
Introduction :
Chronic low back pain (CLBP) is associated with disability and psychological consequences. Pain control and fear-avoidance are common yet ineffective strategies. Exercise intervention and Acceptance and Commitment Therapy (ACT) are effective for CLBP. Recent studies reported promising results from individual exercise informed by ACT. In a local out-patient physiotherapy clinic (PTOPC), previous group exercise combined with psychological approach showed promising outcomes for elderly CLBP patients. A group exercise programme in physiotherapy informed by ACT (GrExPACT) was developed.
Objectives :
1) to observe feasibility of GrExPACT amongst elderly CLBP patients;
2) to evaluate effectiveness of GrExPACT versus exercise (Ex) control
Methodology :
This was a (unrandomised) control study. Elderly CLBP patients in a PTOPC were screened with STarT Back Screening Tool. Those with high or medium psychosocial risks were conveniently offered either GrExPACT or Ex. GrExPACT was a 5-weekly group intervention (105 minutes each) delivered by a physiotherapist who was trained by clinical psychologists on metaphors and mindfulness for ACT. Audio records were reviewed for competency. Experiential movements and exposure with psychological skills following a protocol help enhance psychological flexibility for an open (willing to experience), aware (of present moment) and active (engaging toward one’s goal through value-based actions) behaviour. Back care was discussed in Ex group. Progressive exercise was practised for both interventions with follow-up (FU) at 3 months. Outcomes included Roland Morris Disability Questionnaire (RMDQ), Pain Self-efficacy Questionnaire (PSEQ) and Chronic Pain Acceptance Questionnaire – activity engagement (CPAQ-8-AE). T-tests were conducted for within and between group difference (BGD).
Result & Outcome :
Totally 213 patients were recruited, 157(73.7%) for GrExPACT and 56(26.3%) Ex. Their mean(SD) age was 72.8(6.8) and 73.2% female, with 3.9(4.4) years of CLBP. 60% had high psychosocial risks. At baseline, RMDQ was different (ρ =0.012) between GrExPACT [mean(SD) 15.48(5.28)] and Ex [13.41(5.11)]. PSEQ was different (ρ =0.035) between GrExPACT [32.84(11.68)] and Ex [36.70(12.44)]. Retention rate (attended the last session) for GrExPACT was 77.1% (4.1 sessions) and Ex 87.5% (4.2 sessions). GrExPACT had RMDQ improved to 9.34(4.79) (ρ =0.000) post-intervention and 10.34(4.89) (ρ =0.000) FU. For Ex, RMDQ was 9.58(4.82) (ρ =0.000) post-intervention and 11.05(4.87) (ρ =0.001) FU. BGD was significant at post-intervention (t=-2.798, ρ =0.006) and FU (t=-2.319, ρ =0.022). Mean difference for PSEQ in GrExPACT was 8.92(11.94) (ρ =0.000) and Ex 3.35(12.04) (ρ =0.045) post-intervention (BGD ρ =0.007). CPAQ-8-AE was improved by 2.82(5.28) (ρ =0.000) for GrExPACT but worsen by 0.35(5.10) for Ex (BGD ρ =0.000). GrExPACT is feasible in CLBP management, demonstrating potentially greater improvement in disability, self-efficacy and acceptance/engagement over exercise at medium term. A randomized study is needed to confirm the results.
