Client-centered therapy vs exercise therapy for chronic low back pain: A pilot randomized controlled trial in Brazil

Background. Psychological interventions targeting maladaptive pain behaviors and depressive symptoms are commonly used in the management of chronic pain. Objective. To compare the effectiveness of psychotherapy, based on client-centered therapy, and exercise for patients with chronic nonspecific low back pain (LBP). Setting. Outpatient physiotherapy and psychotherapy departments within a Brazilian academic institution. Design. Thirty-three patients with chronic nonspecific LBP were recruited and randomized to receive client-centered therapy (N = 16) or exercise (N = 17) for 9 weeks. Outcome Measures and Data Analysis. Pain and disability were measured at baseline, 9 weeks, and 6 months by a 10-cm visual analog scale and by the Brazilian Roland-Morris Questionnaire, respectively. Depression was measured at baseline and 9 weeks by the Beck Depression Inventory. Multiple regression analyses with baseline scores as covariates were used to determine the effects of treatment on outcomes. Results. For all outcomes at each time point, the exercise group showed greater improvements than psychotherapy. The difference between groups was statistically and clinically significant for disability at 9 weeks (-4.9 points, 95% CI -9.08 to -0.72). Conclusions. This was the first study to investigate the effects of client-centered therapy and exercise for patients with chronic LBP. Our results showed that client-centered therapy is less effective than exercise in reducing disability at short term.