The effects of telehealth-delivered mindfulness meditation, cognitive therapy, and behavioral activation for chronic low back pain: a randomized clinical trial.
Study Goal
The researchers aimed to evaluate the immediate and longer-term effects of group, videoconference-delivered mindfulness meditation (MM) compared to cognitive therapy (CT) and behavioral activation (BA) for chronic low back pain (CLBP).
Results Summary
Mindfulness meditation showed medium-to-large effect size reductions in pain interference, with gains maintained at 3- and 6-month follow-ups. No significant differences were found between MM, CT, and BA, except for sleep disturbance, which improved more in BA than MM.
Population
Adults with chronic low back pain (N = 302).
Effective Dosage
Not specified
Duration
Not specified (primary endpoint was post-treatment, with follow-ups at 3 and 6 months).
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
behavioral activation (BA) | decrease | pain interference | adults with CLBP | ds from - .71 to - 1.00 | Medium-to-large effect size reductions | #1 |
cognitive therapy (CT) | decrease | pain interference | adults with CLBP | ds from - .71 to - 1.00 | Medium-to-large effect size reductions | #2 |
mindfulness meditation (MM) | decrease | pain interference | adults with CLBP | ds from - .71 to - 1.00 | Medium-to-large effect size reductions | #3 |
behavioral activation (BA) | decrease | secondary outcomes | adults with CLBP | ds from - .20 to - .71 | small to medium effect sizes | #4 |
cognitive therapy (CT) | decrease | secondary outcomes | adults with CLBP | ds from - .20 to - .71 | small to medium effect sizes | #5 |
mindfulness meditation (MM) | decrease | secondary outcomes | adults with CLBP | ds from - .20 to - .71 | small to medium effect sizes | #6 |
behavioral activation (BA) | decrease | sleep disturbance | adults with CLBP | d = - .49 | improving more | #7 |
mindfulness meditation (MM) | decrease | sleep disturbance | adults with CLBP | - | improving less | #8 |
group, videoconference-delivered CT, BA, and MM | neutral | CLBP | adults with CLBP | - | effective | #9 |
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03687762.