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Does pain-catastrophising mediate the effect of tai chi on treatment outcomes for people with low back pain?
Complement Ther Med. 2016 Apr; 25:61-6.CT

Abstract

OBJECTIVES

There is evidence to support the effectiveness of tai chi for reducing pain-related symptoms across multiple musculoskeletal conditions, however, the mechanism(s) are unclear. This study explores the role of pain-catastrophising as a possible mediator in the relationship between practising tai chi and back pain symptoms.

DESIGN

Exploratory mediation analyses using a Baron and Kenny approach and bootstrapping methods were employed as a secondary analysis of data from a previously published randomised controlled trial.

SETTING

Adults with persistent low back pain were recruited via community advertisement in Sydney, NSW, Australia.

INTERVENTIONS

A 10-week tai chi intervention and a wait-list control.

MAIN OUTCOME MEASURES

Patients completed self-assessments of pain intensity and bothersomeness using 0-10 numerical rating scales, disability using the Roland Morris Disability Questionnaire and pain catastrophising using the Pain Coping Strategies Questionnaire pre and post intervention.

RESULTS

The results suggest partial mediation, by which a reduction in catastrophising explained approximately 1/3 of the effect on pain intensity and bothersomeness and 2/3 of the effect on disability.

CONCLUSION

As the first known mediation analysis of tai chi for reducing low back pain-symptoms, it provides initial evidence that it may do so by having an effect on cognitive appraisal outcomes such as pain-catastrophising and information for choosing appropriate process measures for future studies. As tai chi is growing in popularity as an alternative treatment for patients with chronic musculoskeletal conditions, it is important to gain a better understanding of how it might work using confirmatory mediation analysis alongside future RCTs.

Authors+Show Affiliations

Nuffield Department of Population Health, The George Institute for Global Health, University of Oxford, Oxford, United Kingdom. Electronic address: amanda.hall@georgeinstitute.ox.ac.uk.Musculoskeletal Division, The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia(1); EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands.Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, United Kingdom.Musculoskeletal Division, The George Institute for Global Health, The University of Sydney, Sydney, NSW, Australia(1).

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27062950

Citation

Hall, Amanda M., et al. "Does Pain-catastrophising Mediate the Effect of Tai Chi On Treatment Outcomes for People With Low Back Pain?" Complementary Therapies in Medicine, vol. 25, 2016, pp. 61-6.
Hall AM, Kamper SJ, Emsley R, et al. Does pain-catastrophising mediate the effect of tai chi on treatment outcomes for people with low back pain? Complement Ther Med. 2016;25:61-6.
Hall, A. M., Kamper, S. J., Emsley, R., & Maher, C. G. (2016). Does pain-catastrophising mediate the effect of tai chi on treatment outcomes for people with low back pain? Complementary Therapies in Medicine, 25, 61-6. https://doi.org/10.1016/j.ctim.2015.12.013
Hall AM, et al. Does Pain-catastrophising Mediate the Effect of Tai Chi On Treatment Outcomes for People With Low Back Pain. Complement Ther Med. 2016;25:61-6. PubMed PMID: 27062950.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does pain-catastrophising mediate the effect of tai chi on treatment outcomes for people with low back pain? AU - Hall,Amanda M, AU - Kamper,Steven J, AU - Emsley,Richard, AU - Maher,Christopher G, Y1 - 2016/01/02/ PY - 2015/07/13/received PY - 2015/11/30/revised PY - 2015/12/26/accepted PY - 2016/4/12/entrez PY - 2016/4/12/pubmed PY - 2017/1/6/medline KW - Disability KW - Low back pain KW - Pain KW - Pain-catastrophising KW - Randomised controlled trial KW - Tai chi SP - 61 EP - 6 JF - Complementary therapies in medicine JO - Complement Ther Med VL - 25 N2 - OBJECTIVES: There is evidence to support the effectiveness of tai chi for reducing pain-related symptoms across multiple musculoskeletal conditions, however, the mechanism(s) are unclear. This study explores the role of pain-catastrophising as a possible mediator in the relationship between practising tai chi and back pain symptoms. DESIGN: Exploratory mediation analyses using a Baron and Kenny approach and bootstrapping methods were employed as a secondary analysis of data from a previously published randomised controlled trial. SETTING: Adults with persistent low back pain were recruited via community advertisement in Sydney, NSW, Australia. INTERVENTIONS: A 10-week tai chi intervention and a wait-list control. MAIN OUTCOME MEASURES: Patients completed self-assessments of pain intensity and bothersomeness using 0-10 numerical rating scales, disability using the Roland Morris Disability Questionnaire and pain catastrophising using the Pain Coping Strategies Questionnaire pre and post intervention. RESULTS: The results suggest partial mediation, by which a reduction in catastrophising explained approximately 1/3 of the effect on pain intensity and bothersomeness and 2/3 of the effect on disability. CONCLUSION: As the first known mediation analysis of tai chi for reducing low back pain-symptoms, it provides initial evidence that it may do so by having an effect on cognitive appraisal outcomes such as pain-catastrophising and information for choosing appropriate process measures for future studies. As tai chi is growing in popularity as an alternative treatment for patients with chronic musculoskeletal conditions, it is important to gain a better understanding of how it might work using confirmatory mediation analysis alongside future RCTs. SN - 1873-6963 UR - https://www.unboundmedicine.com/medline/citation/27062950/Does_pain_catastrophising_mediate_the_effect_of_tai_chi_on_treatment_outcomes_for_people_with_low_back_pain L2 - https://linkinghub.elsevier.com/retrieve/pii/S0965-2299(15)30034-0 DB - PRIME DP - Unbound Medicine ER -