Psychosocial moderators and mediators of sensorimotor exercise in low back pain: a randomized multicenter controlled trial

  • The effects of exercise interventions on unspecific chronic low back pain (CLBP) have been investigated in many studies, but the results are inconclusive regarding exercise types, efficiency, and sustainability. This may be because the influence of psychosocial factors on exercise induced adaptation regarding CLBP is neglected. Therefore, this study assessed psychosocial characteristics, which moderate and mediate the effects of sensorimotor exercise on LBP. A single-blind 3-arm multicenter randomized controlled trial was conducted for 12-weeks. Three exercise groups, sensorimotor exercise (SMT), sensorimotor and behavioral training (SMT-BT), and regular routines (CG) were randomly assigned to 662 volunteers. Primary outcomes (pain intensity and disability) and psychosocial characteristics were assessed at baseline (M1) and follow-up (3/6/12/24 weeks, M2-M5). Multiple regression models were used to analyze whether psychosocial characteristics are moderators of the relationship between exercise and pain, meaning that psychosocial factors and exercise interact. Causal mediation analysis were conducted to analyze, whether psychosocial characteristics mediate the exercise effect on pain. A total of 453 participants with intermittent pain (mean age = 39.5 ± 12.2 years, f = 62%) completed the training. It was shown, that depressive symptomatology (at M4, M5), vital exhaustion (at M4), and perceived social support (at M5) are significant moderators of the relationship between exercise and the reduction of pain intensity. Further depressive mood (at M4), social-satisfaction (at M4), and anxiety (at M5 SMT) significantly moderate the exercise effect on pain disability. The amount of moderation was of clinical relevance. In contrast, there were no psychosocial variables which mediated exercise effects on pain. In conclusion it was shown, that psychosocial variables can be moderators in the relationship between sensorimotor exercise induced adaptation on CLBP which may explain conflicting results in the past regarding the merit of exercise interventions in CLBP. Results suggest further an early identification of psychosocial risk factors by diagnostic tools, which may essential support the planning of personalized exercise therapy.

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Author:Pia-Maria WippertORCiDGND, Daniel NiedererORCiDGND, David Drießlein, Heidrun Beck, Winfried BanzerGND, Christian Schneider, Marcus SchiltenwolfORCiDGND, Frank Mayer
Parent Title (English):Frontiers in psychiatry
Publisher:Frontiers Research Foundation
Place of publication:Lausanne
Document Type:Article
Date of Publication (online):2021/07/29
Date of first Publication:2021/07/29
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2021/10/15
Tag:MiSpEx-network; low-back-pain; motor-control-exercise; multidisciplinary-therapy; yellow flags
Issue:art. 629474
Page Number:16
First Page:1
Last Page:16
The present study was funded by the German Federal Institute of Sport Science on behalf of the Federal Ministry of the Interior of Germany as the major funder. It is realized within MiSpEx – the National Research Network for Medicine in Spine Exercise (grant-number: 080102A/11-14). The funder does not influence data collection, analysis, and interpretation or writing of the manuscript. The authors declare that they have no competing interests. We further acknowledge the support of the Deutsche Forschungsgemeinschaft the Open Access Publishing Fund of the University of Potsdam.
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0