1. To compare the effects of an 8-week ACT plus exercise program versus an 8-week patient education plus exercise program on health-related outcomes in community-dwelling older adults with chronic low back pain (CLBP) immediately post-treatment and at 6 months follow-up.
2. To explore patients' experiences of the two intervention programs.
This 2-arm, double-blind, pilot cluster-randomized controlled trial (RCT), with embedded qualitative research investigated the feasibility and compared the effects of an 8-week ACT plus exercise program (n=20) versus an 8-week patient education plus exercise program (n=20) on subjective and objective outcomes in community-dwelling older adults with CLBP, immediately post-treatment and at 6 months follow-up.
Self-reported outcomes included pain intensity, CLBP-related disability (Roland Morris Disability Questionnaires, RMDQ), psychological inflexibility (Acceptance and Action Questionnaire-Version 2, AAQ-II), health-related quality of life (EuroQol-5 Dimensions, EQ-5D-5L), and psychological well-being (Depression Anxiety Stress Scale). Physical fitness was assessed through various tests including time up and go test (TUG), functional reach test (FRT), 30s sit to stand test (STS-30), six minutes walking test (6MWT), and hand grip strength.
This trial achieved high recruitment eligibility (85.1%) and completion rates (92.5%). Pain intensity improved over time in both groups. The ACT plus exercise program demonstrated significant improvements in disability, psychological inflexibility, and Time Up and Go speed immediately post-treatment, while no significant improvements were observed in the control group at this time point. Qualitative data identified 3 superordinate themes: previous healthcare experience affecting pain beliefs; ACT offering a novel perspective on coping with pain; and facilitators and barriers to treatment compliance.
ACT plus exercise offers benefits in improving pain, disability, psychological inflexibility, HRQoL, and mobility in older adults with CLBP. These findings support the need for a definitive RCT and may form a valuable basis for future exploration regarding the behavioral mechanisms and clinical applications of ACT.
These findings provide valuable insights into the potential effectiveness of ACT for CLBP management, emphasizing its impact on both physical outcomes and patient experiences. The qualitative research highlights the specific needs of older adults with CLBP and offers a foundation for optimizing multimodal interventions.
acceptance and commitment therapy
commuity-dwelling older people
