How does change unfold? an evaluation of the process of change in four people with chronic low back pain and high pain-related fear managed with Cognitive Functional Therapy: A replicated single-case experimental design study

Movement, posture and low back pain. How do they relate? A replicated single‐case design in 12 people with persistent, disabling low back pain

“…For example, forward bending was the most disabling pain-provoking task for both P12 and P07, yet P12 showed a significant and strong relationship with EMG, while P07 showed no strong relationship with EMG. This heterogeneity is supported by previous research utilizing a similar design that identified unique patterns of change and variable relationships between proposed mediators and disability across four participants with persistent, disabling NSLBP and high pain-related fear (Caneiro et al, 2019). Notably, Caneiro et al (2019) related two self-report variables, while the current study related an objectively measured and a self-report variable, reducing the potential bias present when correlating two self-report variables.…”

“…This heterogeneity is supported by previous research utilizing a similar design that identified unique patterns of change and variable relationships between proposed mediators and disability across four participants with persistent, disabling NSLBP and high pain-related fear (Caneiro et al, 2019). Notably, Caneiro et al (2019) related two self-report variables, while the current study related an objectively measured and a self-report variable, reducing the potential bias present when correlating two self-report variables. It appears that people with NSLBP likely have unique and individually relevant relationships between numerous biopsychosocial factors that influence their presentation and clinical outcome.…”

“…The strength of the correlation coefficients was assessed as nonsignificant, small (r = 0.10 to <0.30), medium (r = 0.30 to <0.50) and large (r = ≥0.50) (Cohen, 1988). As per previous research utilizing cross-correlation analysis to examine temporal associations between variables in people with persistent, disabling LBP undergoing CFT intervention (Caneiro, Smith, Linton, Moseley, & O'Sullivan, 2019) correlations between movement or posture, and pain and activity limitation were estimated over a series of five time-lags from −2 to +2 weeks. This allowed consideration of the potential for change in movement or posture to either precede (positive lag), follow (negative lag), or occur concurrently (zero lag) with changes in pain or activity limitation over a 4-week period.…”

“…It appears that people with NSLBP likely have unique and individually relevant relationships between numerous biopsychosocial factors that influence their presentation and clinical outcome. In heterogenous and complex conditions, rigorous single-case designs with repeated measures provide an opportunity to gather insight into the complex interplay between multiple factors of interest from a within-person, individualized perspective (Caneiro et al, 2019;Kratochwill et al, 2012).…”

“…CFT targets both individually relevant movements and postures identified as painful and disabling for the person, as well as the cognitive and emotional factors that underpin them (O'Sullivan et al, 2018). It has shown promising results in the reduction of pain and activity limitation (Caneiro et al, 2019; Skouen, Smith, & Kvåle, 2013;Vibe Fersum, Smith, Kvale, Skouen, & O'Sullivan, 2019), and therefore provided an opportunity to create change, facilitating the investigation of relationships between movement, posture, pain, and activity limitation.…”