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Exploring what factors mediate treatment effect: Example of the STarT Back study high-risk intervention

Mansell, Gemma; Hill, Jonathan; Main, Chris; Vowles, Kevin E.; Van Der Windt, Danielle

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Authors

Gemma Mansell

Chris Main

Kevin E. Vowles



Abstract

Interventions developed to improve disability outcomes for low back pain (LBP) often show only small effects. Mediation analysis was used to investigate what led to the effectiveness of the STarT Back trial, a large primary care-based trial that treated patients consulting with LBP according to their risk of a poor outcome. The high-risk subgroup, randomized to receive either psychologically-informed physiotherapy (n = 93) or current best care (n = 45), was investigated to explore pain-related distress and pain intensity as potential mediators of the relationship between treatment allocation and change in disability. Structural equation modeling was used to generate latent variables of pain-related distress and pain intensity from measures used to identify patients at high risk (fear-avoidance beliefs, depression, anxiety, and catastrophizing thoughts). Outcome was measured using the Roland–Morris Disability Questionnaire. Change in pain-related distress and pain intensity were found to have a significant mediating effect of .25 (standardized estimate, bootstrapped 95% confidence interval, .09–.39) on the relationship between treatment group allocation and change in disability outcome. This study adds to the evidence base of treatment mediation studies in pain research and the role of distress in influencing disability outcome in those with complex LBP.

Journal Article Type Article
Acceptance Date Aug 15, 2016
Online Publication Date Aug 24, 2016
Publication Date 2016
Publicly Available Date Mar 28, 2024
Journal Journal of Pain
Print ISSN 1526-5900
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 17
Issue 11
Pages 1237-1245
DOI https://doi.org/10.1016/j.jpain.2016.08.005
Keywords meditation analysis; low back pain; psychological intervention
Publisher URL https://doi.org/10.1016/j.jpain.2016.08.005