Mechanisms of education and graded sensorimotor retraining in people with chronic low back pain: a mediation analysis

Review written by Ben Cormack info

Key Points

  1. It is important to find out HOW interventions work, not just if they do work and the magnitude of that effect.
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BACKGROUND & OBJECTIVE

There are two key questions to be answered with interventions currently in rehabilitation. Firstly, the question is if a treatment has a worthwhile effect for patients. Secondly, how a treatment might work so that a treatment can be optimized and then integrated into clinical practice in the most efficient way (1). Mediating variables are used to explain how an intervention may exert its effect. A mediator is an intermediate variable that may be affected by an exposure (intervention) and may in turn lead to changes in an outcome (2).

This mediation analysis focused on the question of how a specific education and sensorimotor intervention may influence back pain and was performed on the RESOLVE RCT that was published in 2021. It aimed to investigate whether and to what extent the hypothesized, theory-driven mechanisms mediated the effect of this education and graded sensorimotor retraining intervention on pain and disability.

A mediator is an intermediate variable that may be affected by an intervention and may in turn lead to changes in an outcome.
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The move from physical to more psychological based mediators should naturally bring about a change in how clinicians’ practice.

METHODS

  • This randomized controlled trial (RCT) explored an intervention that was based on “education and graded sensorimotor retraining” and was designed around a new understanding of chronic pain. It was devised to target maladaptive conceptualisations of pain, sensory and motor function
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