393: Treatment effect modifiers of graded sensorimotor retraining for people with chronic low back pain

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Non-pharmacological treatments, Physiotherapy (e.g. exercise, rehab), Treatment/management

Background and Aims: Outcomes of low back pain management may be improved through targeting treatments to patient subgroups who share characteristics. Graded sensorimotor retraining is a theoretically informed treatment (1) for chronic low back pain, which demonstrated clinically meaningful and sustained improvements in pain intensity and disability in a sham-controlled randomised trial. (2) Variables that modify the effect of graded sensorimotor retraining need investigation to facilitate optimization and implementation of this treatment for people with chronic low back pain. (3) This study aims to investigate potential treatment effect modifiers of graded sensorimotor retraining on pain intensity and disability in the short and long-term.

Methods: This study was a secondary analysis of the RESOLVE 2-group randomised clinical trial. Participants with chronic non-specific low back pain recruited from primary care were randomised (1:1) to either graded sensorimotor retraining or a sham control. Eight prespecified baseline variables were investigated for treatment effect modification using linear regression models with statistical interaction tests. Primary outcomes were pain intensity (11- point numerical rating scale; range, 0 [no pain] to 10 [worst imaginable pain]) and disability (24- item Roland Morris Disability Questionnaire; scale range, 0-24 [higher scores indicate greater disability]) assessed at baseline, and 18 week and 52 weeks post randomisation.

Results: 276 adults were randomised. Participants had a mean (SD) age of 46 (14.3) and 50% (n=138) were female. Pain self-efficacy, pain catastrophising, baseline pain intensity and psychoactive medication use did not have evidence for effect modification. Impaired back perception was identified as a potential treatment effect modifier of pain (Interaction effect 0.18, 95% CI 0.05 to 0.32; p=0.007) at 52 weeks post randomisation. Hypothesis generating evidence (p<0.2) was identified for effect modification by kinesiophobia, baseline disability, back beliefs and back perception.

Conclusions: The benefits of graded sensorimotor retraining are likely to be similar for most people presenting for care with chronic non-specific low back pain. Future clinical trials should further investigate exploratory effect modifiers identified in this study to assess their importance in the field of low back pain management.

References: (1) Wand BM, Cashin AG, McAuley JH, Bagg MK, Orange GM, Moseley GL. The Fit-for-Purpose Model: Conceptualizing and Managing Chronic Nonspecific Low Back Pain as an Information Problem. Phys Ther. Feb 1 2023;103(2)
(2) Bagg MK, Wand BM, Cashin AG, et al. Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients With Chronic Low Back Pain: A Randomized Clinical Trial. Jama. Aug 2 2022;328(5):430-439.
(3) Costa LdCM, Koes BW, Pransky G, Borkan J, Maher CG, Smeets RJEM. Primary Care Research Priorities in Low Back Pain: An Update. Spine. 2013;38(2)

Presenting Author: Martjie Venter
Submitting Author: Martjie Venter

Senior Author: Aidan G Cashin

IASP 2026 Global Year theme of Neuropathic Pain: No

• Martjie Venter: MPhysio - University of New South Wales and Neuroscience Research Australia
• James H McAuley: PhD - University of New South Wales and Neuroscience Research Australia
• Harrison J Hansford: BSc(Hons) - University of New South Wales and Neuroscience Research Australia
• Mia Ryan: BSc(Hons) - Neuroscience Research Australia
• Matthew K Bagg: PhD - The University of Notre Dame Australia
• Benedict M Wand: PhD - The University of Notre Dame Australia
• Aidan G Cashin: PhD - University of New South Wales and Neuroscience Research Australia