Pain catastrophising and kinesiophobia mediate pain and physical function improvements with Pilates exercise in chronic low back pain: a mediation analysis of a randomised controlled trial
Question: How much are the reductions in pain intensity and improvements in physical function from Pilates exercise mediated by changes in pain catastrophising and kinesiophobia? Design: This was a secondary causal mediation analysis of a four-arm randomised controlled trial testing Pilates exercise...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-07-01
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| Series: | Journal of Physiotherapy |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1836955323000437 |
| _version_ | 1797792614449152000 |
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| author | Lianne Wood Geronimo Bejarano Ben Csiernik Gisela C Miyamoto Gemma Mansell Jill A Hayden Martyn Lewis Aidan G Cashin |
| author_facet | Lianne Wood Geronimo Bejarano Ben Csiernik Gisela C Miyamoto Gemma Mansell Jill A Hayden Martyn Lewis Aidan G Cashin |
| author_sort | Lianne Wood |
| collection | DOAJ |
| description | Question: How much are the reductions in pain intensity and improvements in physical function from Pilates exercise mediated by changes in pain catastrophising and kinesiophobia? Design: This was a secondary causal mediation analysis of a four-arm randomised controlled trial testing Pilates exercise dosage (once, twice or thrice per week) against a booklet control. Participants: Two hundred and fifty-five people with chronic low back pain. Data analysis: All analyses were conducted in R software (version 4.1.2) following a preregistered analysis plan. A directed acyclic graph was constructed to identify potential pre-treatment mediator-outcome confounders. For each mediator model, we estimated the intervention-mediator effect, the mediator-outcome effect, the total natural indirect effect (TNIE), the pure natural direct effect (PNDE), and the total effect (TE). Results: Pain catastrophising mediated the effect of Pilates exercise compared with control on the outcomes pain intensity (TNIE MD –0.21, 95% CI –0.47 to –0.03) and physical function (TNIE MD –0.64, 95% CI –1.20 to –0.18). Kinesiophobia mediated the effect of Pilates exercise compared with control on the outcomes pain intensity (TNIE MD –0.31, 95% CI –0.68 to –0.02) and physical function (TNIE MD –1.06, 95% CI –1.70 to –0.49). The proportion mediated by each mediator was moderate (21 to 55%). Conclusion: Reductions in pain catastrophising and kinesiophobia partially mediated the pathway to improved pain intensity and physical function when using Pilates exercise for chronic low back pain. These psychological components may be important treatment targets for clinicians and researchers to consider when prescribing exercise for chronic low back pain. |
| first_indexed | 2024-03-13T02:36:33Z |
| format | Article |
| id | doaj.art-a9c8ed7543944cd1a8544a979d055326 |
| institution | Directory Open Access Journal |
| issn | 1836-9553 |
| language | English |
| last_indexed | 2024-03-13T02:36:33Z |
| publishDate | 2023-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Physiotherapy |
| spelling | doaj.art-a9c8ed7543944cd1a8544a979d0553262023-06-29T04:14:11ZengElsevierJournal of Physiotherapy1836-95532023-07-01693168174Pain catastrophising and kinesiophobia mediate pain and physical function improvements with Pilates exercise in chronic low back pain: a mediation analysis of a randomised controlled trialLianne Wood0Geronimo Bejarano1Ben Csiernik2Gisela C Miyamoto3Gemma Mansell4Jill A Hayden5Martyn Lewis6Aidan G Cashin7Spinal Surgical Division, Nottingham University Hospitals NHS Trust, Nottingham, UK; School of Medicine, Keele University, Newcastle-under-Lyme, UK; Faculty of Health and Life Sciences, University of Exeter, Exeter, UK; Correspondence: Lianne Wood, Faculty of Health and Life Sciences, University of Exeter, UK.University of Texas Health Science Center (UTHealth), Austin, Texas, USADepartment of Health Sciences, Ontario Tech University, Oshawa, Ontario, CanadaMasters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, BrazilSchool of Psychology, College of Health & Life Sciences, Aston University, Aston Triangle, Birmingham, UKDepartment of Community Health and Epidemiology, Dalhousie University, Halifax, CanadaSchool of Medicine, Keele University, Newcastle-under-Lyme, UKCentre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia; School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, AustraliaQuestion: How much are the reductions in pain intensity and improvements in physical function from Pilates exercise mediated by changes in pain catastrophising and kinesiophobia? Design: This was a secondary causal mediation analysis of a four-arm randomised controlled trial testing Pilates exercise dosage (once, twice or thrice per week) against a booklet control. Participants: Two hundred and fifty-five people with chronic low back pain. Data analysis: All analyses were conducted in R software (version 4.1.2) following a preregistered analysis plan. A directed acyclic graph was constructed to identify potential pre-treatment mediator-outcome confounders. For each mediator model, we estimated the intervention-mediator effect, the mediator-outcome effect, the total natural indirect effect (TNIE), the pure natural direct effect (PNDE), and the total effect (TE). Results: Pain catastrophising mediated the effect of Pilates exercise compared with control on the outcomes pain intensity (TNIE MD –0.21, 95% CI –0.47 to –0.03) and physical function (TNIE MD –0.64, 95% CI –1.20 to –0.18). Kinesiophobia mediated the effect of Pilates exercise compared with control on the outcomes pain intensity (TNIE MD –0.31, 95% CI –0.68 to –0.02) and physical function (TNIE MD –1.06, 95% CI –1.70 to –0.49). The proportion mediated by each mediator was moderate (21 to 55%). Conclusion: Reductions in pain catastrophising and kinesiophobia partially mediated the pathway to improved pain intensity and physical function when using Pilates exercise for chronic low back pain. These psychological components may be important treatment targets for clinicians and researchers to consider when prescribing exercise for chronic low back pain.http://www.sciencedirect.com/science/article/pii/S1836955323000437ExerciseLow back painMediation analysisPilatesPhysical therapy |
| spellingShingle | Lianne Wood Geronimo Bejarano Ben Csiernik Gisela C Miyamoto Gemma Mansell Jill A Hayden Martyn Lewis Aidan G Cashin Pain catastrophising and kinesiophobia mediate pain and physical function improvements with Pilates exercise in chronic low back pain: a mediation analysis of a randomised controlled trial Journal of Physiotherapy Exercise Low back pain Mediation analysis Pilates Physical therapy |
| title | Pain catastrophising and kinesiophobia mediate pain and physical function improvements with Pilates exercise in chronic low back pain: a mediation analysis of a randomised controlled trial |
| title_full | Pain catastrophising and kinesiophobia mediate pain and physical function improvements with Pilates exercise in chronic low back pain: a mediation analysis of a randomised controlled trial |
| title_fullStr | Pain catastrophising and kinesiophobia mediate pain and physical function improvements with Pilates exercise in chronic low back pain: a mediation analysis of a randomised controlled trial |
| title_full_unstemmed | Pain catastrophising and kinesiophobia mediate pain and physical function improvements with Pilates exercise in chronic low back pain: a mediation analysis of a randomised controlled trial |
| title_short | Pain catastrophising and kinesiophobia mediate pain and physical function improvements with Pilates exercise in chronic low back pain: a mediation analysis of a randomised controlled trial |
| title_sort | pain catastrophising and kinesiophobia mediate pain and physical function improvements with pilates exercise in chronic low back pain a mediation analysis of a randomised controlled trial |
| topic | Exercise Low back pain Mediation analysis Pilates Physical therapy |
| url | http://www.sciencedirect.com/science/article/pii/S1836955323000437 |
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