Effectiveness and mechanisms of a multimodal treatment for low back pain: a pragmatic matched cohort study Article Swipe
Robin Schäfer
,
Daniel Niederer
,
Claudia Levenig
,
Monika Hasenbring
,
Thomas Tas
,
Daniela Fett
,
Katharina Trompeter
,
Thore Haag
,
Christian Schneider
,
Philipp Floessel
,
Heidrun Beck
,
Marcus Schiltenwolf
,
Pia‐Maria Wippert
,
Tilman Engel
,
Frank Mayer
,
Petra Platen
·
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1101/2022.09.28.22280380
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.1101/2022.09.28.22280380
Objective To investigate the effectiveness and mechanisms of a multimodal treatment including perturbation exercise. Methods A matched cohort study was conducted. The intervention consists of a 12-week back pain prevention course with perturbation exercise and education embedded in primary health care according to German social law. Participants from the intervention group had chronic or recurrent low back pain with heterogenous but on average rather low pain and chronification. Control groups (usual care) were matched from a multi-center RCT. Outcomes were pain, disability, isokinetic trunk strength and balance. Bayesian regression models were used to estimate the Average Treatment effect on the Treated (ATT). Further, sub-group and mediation analyses within the intervention group using the biopsychological avoidance-endurance model were conducted. Median values with highest posterior density intervals (HPDI) from baseline-adjusted analyses are presented. Results Over 12 weeks, intervention and control (n = 128 each) experienced a similar decrease in pain and disability, which led to negligible ATTs for pain (−0.3 (HPDI95% [-4.3, 3.4]) and disability (−0.2 (HPDI95% [-4, 3.7])). Changes in functional parameters (n=18) showed small effects in favor of the intervention group, in particular for monopedal stances (standardized mean difference: -0.5 HPDI95% [-0.79, -0.21]). Depression was higher in drop-outs and decreases in pain/disability were associated with decreases in depression. Distress-endurance subgroups experienced higher baseline pain and disability and showed the highest reductions in both parameters upon completion of the intervention. Conclusion Perturbation exercise with education yielded only small treatment effects in a heterogenous population with rather mild symptoms. Targeting distress-endurance subgroups with a multimodal treatment approach is probably an effective strategy in treatment tailoring.
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Metadata
- Type
- preprint
- Language
- en
- Landing Page
- https://doi.org/10.1101/2022.09.28.22280380
- https://www.medrxiv.org/content/medrxiv/early/2023/02/02/2022.09.28.22280380.full.pdf
- OA Status
- green
- Cited By
- 2
- References
- 47
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4298125772
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4298125772Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1101/2022.09.28.22280380Digital Object Identifier
- Title
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Effectiveness and mechanisms of a multimodal treatment for low back pain: a pragmatic matched cohort studyWork title
- Type
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preprintOpenAlex work type
- Language
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enPrimary language
- Publication year
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2022Year of publication
- Publication date
-
2022-09-30Full publication date if available
- Authors
-
Robin Schäfer, Daniel Niederer, Claudia Levenig, Monika Hasenbring, Thomas Tas, Daniela Fett, Katharina Trompeter, Thore Haag, Christian Schneider, Philipp Floessel, Heidrun Beck, Marcus Schiltenwolf, Pia‐Maria Wippert, Tilman Engel, Frank Mayer, Petra PlatenList of authors in order
- Landing page
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https://doi.org/10.1101/2022.09.28.22280380Publisher landing page
- PDF URL
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https://www.medrxiv.org/content/medrxiv/early/2023/02/02/2022.09.28.22280380.full.pdfDirect link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
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greenOpen access status per OpenAlex
- OA URL
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https://www.medrxiv.org/content/medrxiv/early/2023/02/02/2022.09.28.22280380.full.pdfDirect OA link when available
- Concepts
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Physical therapy, Medicine, Randomized controlled trial, Context (archaeology), Low back pain, Physical medicine and rehabilitation, Generalizability theory, Psychology, Surgery, Developmental psychology, Alternative medicine, Pathology, Biology, PaleontologyTop concepts (fields/topics) attached by OpenAlex
- Cited by
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2Total citation count in OpenAlex
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2025: 1, 2024: 1Per-year citation counts (last 5 years)
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47Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.effectiveness | 5 |
| abstract_inverted_index.intervention. | 229 |
| abstract_inverted_index.chronification. | 68 |
| abstract_inverted_index.pain/disability | 202 |
| abstract_inverted_index.biopsychological | 114 |
| abstract_inverted_index.baseline-adjusted | 128 |
| abstract_inverted_index.Distress-endurance | 209 |
| abstract_inverted_index.distress-endurance | 249 |
| abstract_inverted_index.avoidance-endurance | 115 |
| cited_by_percentile_year.max | 95 |
| cited_by_percentile_year.min | 90 |
| corresponding_author_ids | https://openalex.org/A5023666347 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 16 |
| corresponding_institution_ids | https://openalex.org/I4210141069, https://openalex.org/I904495901 |
| citation_normalized_percentile.value | 0.64033142 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |