The effect of in-session exposure in Fear-Avoidance treatment of chronic low back pain: A randomized controlled trial
Peer reviewed, Journal article
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Background Treatment based on the Fear‐Avoidance (FA) model has been found to be effective with chronic low back pain (CLBP), and in‐vivo exposure of fear evoking movements is proposed as a key change mechanism. Exposure tasks may be conducted in the session (in‐session exposure; ISE), in other real‐life situations (between sessions exposure) as part of homework assignments, or both. Utilising a randomized, controlled dismantling study design, the aim of this study was to examine the unique effects of ISE in FA‐treatment of CLBP. Methods Patients (N = 90) with CLBP as primary medical complaints were randomized to receive six sessions of either (a) FA‐treatment with ISE (FA‐ISE) or (b) FA‐treatment without ISE (FA), allowing for between sessions exposure in both treatment groups. Patients were assessed with a large battery of outcome measures at four time‐points (pre‐treatment, post‐treatment, after a booster‐session and at 1‐year follow‐up) including pain intensity, pain catastrophising, self‐efficacy, physical performance and quality of life. Results Both treatment groups (FA‐ISE, FA) demonstrated statistically significant improvements on primary and most secondary outcomes, with mostly non‐significant between‐group differences. Conclusions No added benefit was found for the inclusion of ISE of feared movements in FA‐treatment for CLBP, delivered in a group format to participants with moderately elevated levels of fear‐avoidance beliefs. Clinical trials: NCT01158339. Significance This study adds to the existing research literature demonstrating FA‐treatment to be effective with CLBP, but further experimental studies are needed in order to examine under what circumstances ISE of feared movements may add to positive treatment outcomes.