J P Caneiro1, Anne Smith2, Steven J Linton3, G Lorimer Moseley4, Peter O'Sullivan5. 1. Curtin University, School of Physiotherapy and Exercise Science, GPO Box U1987, Perth, WA 6845, Australia; Body Logic Physiotherapy, 215 Nicholson Rd., Shenton Park, WA 6008, Australia. Electronic address: jp.caneiro@curtin.edu.au. 2. Curtin University, School of Physiotherapy and Exercise Science, GPO Box U1987, Perth, WA 6845, Australia. Electronic address: Anne.Smith@curtin.edu.au. 3. Örebro University, Center for Health and Medical Psychology (CHAMP), Örebro University, SE-701 82, Örebro, Sweden. Electronic address: Steven.Linton@oru.se. 4. University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia. Electronic address: Lorimer.Moseley@unisa.edu.au. 5. Curtin University, School of Physiotherapy and Exercise Science, GPO Box U1987, Perth, WA 6845, Australia; Body Logic Physiotherapy, 215 Nicholson Rd., Shenton Park, WA 6008, Australia. Electronic address: P.OSullivan@curtin.edu.au.
Abstract
PURPOSE: To understand the process of change at an individual level, this study used a single-case experimental design to evaluate how change in potential mediators related to change in disability over time, during an exposure-based behavioural intervention in four people with chronic low back pain and high pain-related fear. A second aim was to evaluate whether the change (sequential or simultaneous) in mediators and disability occurred at the same timepoint for all individuals. RESULTS: For all participants, visual and statistical analyses indicated that changes in disability and proposed mediators were clearly related to the commencement of Cognitive Functional Therapy. This was supported by standard outcome assessments at pre-post timepoints. Cross-lag correlation analysis determined that, for all participants, most of the proposed mediators (pain intensity, pain controllability, and fear) were most strongly associated with disability at lag zero, suggesting that mediators changed concomitantly and not before disability. Importantly, these changes occurred at different rates and patterns for different individuals, highlighting the individual temporal variability of change. CONCLUSION: This study demonstrated the interplay of factors associated with treatment response, highlighting 'how change unfolded' uniquely for each individual. The findings that factors underpinning treatment response and the outcome changed simultaneously, challenge the traditional understanding of therapeutic change.
PURPOSE: To understand the process of change at an individual level, this study used a single-case experimental design to evaluate how change in potential mediators related to change in disability over time, during an exposure-based behavioural intervention in four people with chronic low back pain and high pain-related fear. A second aim was to evaluate whether the change (sequential or simultaneous) in mediators and disability occurred at the same timepoint for all individuals. RESULTS: For all participants, visual and statistical analyses indicated that changes in disability and proposed mediators were clearly related to the commencement of Cognitive Functional Therapy. This was supported by standard outcome assessments at pre-post timepoints. Cross-lag correlation analysis determined that, for all participants, most of the proposed mediators (pain intensity, pain controllability, and fear) were most strongly associated with disability at lag zero, suggesting that mediators changed concomitantly and not before disability. Importantly, these changes occurred at different rates and patterns for different individuals, highlighting the individual temporal variability of change. CONCLUSION: This study demonstrated the interplay of factors associated with treatment response, highlighting 'how change unfolded' uniquely for each individual. The findings that factors underpinning treatment response and the outcome changed simultaneously, challenge the traditional understanding of therapeutic change.
Authors: E J Edwin de Raaij; H Harriet Wittink; J F Francois Maissan; J Jos Twisk; R W J G Raymond Ostelo Journal: BMC Musculoskelet Disord Date: 2022-02-11 Impact factor: 2.362
Authors: Aurélie Baillot; Maxime St-Pierre; Josyanne Lapointe; Paquito Bernard; Dale Bond; Ahmed Jérôme Romain; Pierre Y Garneau; Laurent Biertho; André Tchernof; Patricia Blackburn; Marie-France Langlois; Jennifer Brunet Journal: JMIR Res Protoc Date: 2022-09-29