Chronic low back pain (CLBP) is a significant problem affecting millions of people worldwide. Three widely implemented psychological techniques used for CLBP management are cognitive therapy (CT), mindfulness meditation (MM), and behavioral activation (BA). This study aimed to evaluate the relative immediate (pre- to post-treatment) and longer term (pre-treatment to 3- and 6-month follow-ups) effects of group, videoconference-delivered CT, BA, and MM for CLBP. This is a secondary analysis of a three-arm, randomized clinical trial comparing the effects of three active treatments—CT, BA, and MM—with no inert control condition. Participants were N = 302 adults with CLBP, who were randomized to condition. The primary outcome was pain interference, and other secondary outcomes were also examined. The primary study end-point was post-treatment. Intent-to-treat analyses were undertaken for each time point, with the means of the changes in outcomes compared among the three groups using an analysis of variance (ANOVA). Effect sizes and confidence intervals are also reported. Medium-to-large effect size reductions in pain interference were found within BA, CT, and MM (ds from − .71 to − 1.00), with gains maintained at both follow-up time points. Effect sizes were generally small to medium for secondary outcomes for all three conditions (ds from − .20 to − .71). No significant between-group differences in means or changes in outcomes were found at any time point, except for change in sleep disturbance from pre- to post-treatment, improving more in BA than MM (d = − .49). The findings from this trial, one of the largest telehealth trials of psychological treatments to date, critically determined that group, videoconference-delivered CT, BA, and MM are effective for CLBP and can be implemented in clinical practice to improve treatment access. The pattern of results demonstrated similar improvements across treatments and outcome domains, with effect sizes consistent with those observed in prior research testing in-person delivered and multi-modal psychological pain treatments. Thus, internet treatment delivery represents a tool to scale up access to evidence-based chronic pain treatments and to overcome widespread disparities in healthcare. Clinicaltrials.gov, NCT03687762.

中文翻译：

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远程医疗提供的正念冥想、认知疗法和行为激活对慢性腰痛的影响：一项随机临床试验

慢性腰痛（CLBP）是影响全世界数百万人的一个重大问题。用于 CLBP 管理的三种广泛实施的心理技术是认知疗法 (CT)、正念冥想 (MM) 和行为激活 (BA)。本研究旨在评估团体、视频会议提供的 CT、BA 和 MM 对 CLBP 的相对即时（治疗前至治疗后）和长期（治疗前至 3 和 6 个月随访）效果。这是对三组随机临床试验的二次分析，比较了三种活性治疗（CT、BA 和 MM）的效果，且没有惰性对照条件。参与者为 N = 302 名患有 CLBP 的成年人，他们被随机分组​​。主要结果是疼痛干扰，还检查了其他次要结果。主要研究终点是治疗后。对每个时间点进行意向治疗分析，并使用方差分析 (ANOVA) 比较三组之间结果变化的平均值。还报告了效应大小和置信区间。在 BA、CT 和 MM 中发现疼痛干扰的中到大效应大小降低（ds 从 - .71 到 - 1.00），并且在两个随访时间点均保持增益。对于所有三种情况的次要结果，效应大小通常为小到中等（ds 从 - .20 到 - .71）。除了治疗前到治疗后睡眠障碍的变化外，在任何时间点均未发现组间平均值或结果变化存在显着差异，BA 比 MM 改善更多 (d = − .49)。这项试验是迄今为止最大的心理治疗远程医疗试验之一，其结果严格地确定了团体、视频会议提供的 CT、BA 和 MM 对 CLBP 有效，并且可以在临床实践中实施，以改善治疗的可及性。结果模式表明，治疗和结果领域有类似的改善，其效果大小与之前的研究测试中观察到的亲自进行的和多模式心理疼痛治疗中观察到的效果一致。因此，互联网治疗提供是一种扩大循证慢性疼痛治疗的可及性并克服医疗保健领域广泛差异的工具。临床试验.gov，NCT03687762。