The effect of graded exposure therapy in patients with non-specific chronic lower back pain and kinesiophobia in Gauteng, South Africa.
Sandy Lord, Vaneshveri Naidoo, Jasmina Govind
Graded exposure therapy with a pain education session reduced fear of movement and pain in adults with chronic back pain.
No control group, so the true effect is uncertain, but the changes were large and clinically meaningful.
Key findings
1Fear of movement (TSK-11) dropped significantly after the intervention, with a large effect size (Cohen's d = 1.73, 95% CI [1.14, 2.32]).
2Both pain severity and pain interference (BPI-SF) improved significantly, with large effect sizes (Cohen's d = 1.21 and 1.25 respectively).
3The intervention combined a 30-minute pain neuroscience education session with graded exposure to feared activities; the two components were not tested separately, so the contribution of either one alone cannot be determined.
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What it does not show
Single-group design with no control or comparison group, so improvements could reflect natural recovery, placebo, or the passage of time rather than the intervention itself. Small sample from a single hospital site, limiting generalisability. The pain neuroscience education session and graded exposure were delivered together and never isolated, so the individual contribution of each component is unknown. All outcomes were self-reported questionnaires, which are susceptible to expectation and demand bias, especially without a control group to anchor responses. One participant dropped out (positive COVID-19 test), and per-protocol analysis was used rather than intention-to-treat. Recruitment took place during the COVID-19 pandemic, which may have affected the patient pool and the delivery of in-person therapy. The authors themselves recommend a randomised controlled trial to establish the true effect.
Declared interests
The authors state they received no financial support for the research, authorship, or publication of this article.
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