The effect of graded exposure therapy in patients with non-specific chronic lower back pain and kinesiophobia in Gauteng, South Africa

Abstract

Background: Kinesiophobia hampers positive outcomes in patients with non-specific chronic lower back pain (NSCLBP). Graded exposure therapy is a psychosocial approach aimed at increasing patients’ functional capacity by challenging their fears and negative expectations. Objectives: Our study aimed to evaluate the effect of a graded exposure therapy programme on patients with NSCLBP, with primary outcomes assessing changes in pain intensity (Brief Pain Inventory – Short Form [BPI-SF]) and kinesiophobia (Tampa Scale of Kinesiophobia-11 [TSK-11]) from baseline to post-intervention and secondary outcomes assessing changes in pain interference (BPI-SF). Method: A quasi-experimental pre-test and post-test design was used. Twenty-eight participants with NSCLBP for more than 3 months and a TSK-11 score ≥ 22 were recruited. Outcome measures included the TSK-11, BPI-SF and Fear of Daily Activities Questionnaire (FDAQ). The intervention included a 4-week graded exposure programme and pain neuroscience education in the first session only. Data were analysed using the parametric paired t-test and Cohen’s d. Results: Out of 28 participants, most were female (96.4%) with a mean age of 45 (± 8.2) years and reported pain for more than 12 months. Significant improvements were observed on both the TSK-11 and BPI-SF (p < 0.001). Large effect sizes were observed for both kinesiophobia and pain severity (TSK-11: d = 1.73, 95% confidence interval [CI 1.14, 2.32]; BPI Pain Severity: d = 1.21, 95% CI [0.72, 1.70]). Conclusion: Graded exposure therapy was effective in reducing pain and kinesiophobia in patients with NSCLBP in the short term. Clinical implications: Future considerations should be given to implementing the graded exposure therapy in conjunction with other physiotherapy modalities.