Physiotherapy informed by acceptance and commitment therapy for
chronic low back pain: A randomized trial

J 2026

Physiotherapy informed by acceptance and commitment therapy for chronic low back pain: A randomized trial

NEVELIKOVA, Marketa; Filip ZLÁMAL; Filip DOSBABA; Jing Jing SU; Ladislav BAŤALÍK et al.

Základní údaje

Originální název

Physiotherapy informed by acceptance and commitment therapy for chronic low back pain: A randomized trial

Autoři

NEVELIKOVA, Marketa; Filip ZLÁMAL ; Filip DOSBABA; Jing Jing SU a Ladislav BAŤALÍK

Vydání

HONG KONG PHYSIOTHERAPY JOURNAL, SINGAPORE, WORLD SCIENTIFIC PUBL CO PTE LTD, 2026, 1013-7025

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30304 Public and environmental health

Stát vydavatele

Singapur

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 1.000 v roce 2024

Označené pro přenos do RIV

Ano

Organizační jednotka

Lékařská fakulta

Klíčová slova anglicky

Acceptance and commitment therapy; chronic low back pain; exercise motivation; physiotherapy adherence; self-determination theory

Štítky

14110234, 14110525, 14110614

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 16. 4. 2026 12:32, Mgr. Tereza Miškechová

Anotace

V originále

Background: Chronic low back pain (CLBP) is a highly prevalent condition and a leading cause of disability worldwide. Given its complex etiology, there is growing interest in applying the biopsychosocial model to CLBP management in order to address psychological barriers - such as low motivation - that influence pain perception, exercise adherence, and overall treatment outcomes. Physiotherapy-informed Acceptance and Commitment Therapy (PACT) - a third-wave cognitive-behavioral approach - has shown promise in chronic pain management by promoting psychological flexibility and values-based action. Objective: The primary objective of this study is to evaluate patients' exercise motivation of PACT versus usual physiotherapy care (UC). Secondary objectives are to assess and compare the efficacy of PACT versus UC on functioning and disability, adherence to exercise, acceptance of pain and autonomy support from physiotherapists. Both interventions incorporated dynamic neuromuscular stabilization (DNS)-based graded exercise as a core physiotherapy approach. Methods: Fifty patients with CLBP participated in this study. All participants completed paper-and-pencil self-reported questionnaires to assess relevant outcome measures. Data were collected at two time points: baseline (prior to the first therapy session) and at week 6, immediately following the completion of the intervention period (post-intervention). Participants were randomly assigned to one of two groups. The PACT group received ACT-based physiotherapy combined with DNS-based graded exercise. The usual care (UC) group received individualized graded therapeutic exercise based on the DNS concept, complemented by manual therapy. Results: The PACT group showed significantly higher levels of exercise motivation compared to the UC group, with greater scores in introjected motivation (baseline: 4.15 +/- 1.56 versus 3.19 +/- 1.38, p=0.029, r=0.31; post-intervention: 4.49 +/- 1.05 versus 3.27 +/- 1.43, p=0.001, d=0.97) and identified motivation (post-intervention: 6.25 +/- 0.76 versus 5.35 +/- 1.31, p=0.015, r=0.35). Within-group comparisons revealed no significant changes in the UC group, whereas the PACT group demonstrated a decrease in external motivation (diff=-0.40 +/- 0.74, p=0.027, r=0.55) and increases in identified (diff=0.45 +/- 0.95, p<0.034, r=0.54) and intrinsic motivation (diff=0.80 +/- 1.13, p<0.001, r=0.76). Participants in the PACT group also reported significantly higher perceived autonomy support from the physiotherapist (6.52 +/- 0.54, p=0.027) than those in the UC group (5.86 +/- 0.90) (p=0.027, d=0.40). Furthermore, adherence to the recommended physical activity was significantly greater in the PACT group (18.96 +/- 3.17, p<0.001) compared with the UC group (13.32 +/- 2.58) (p<0.001, r=0.71). No statistically significant differences were observed between groups for measures of functioning and pain acceptance, however, both groups demonstrated significant within-group improvements. Disability decreased in UC (diff=-1.04 +/- 1.27, p=0.001, r=0.63) and PACT (diff=-1.08 +/- 2.10, p=0.018, r=0.63) while pain acceptance increased in UC (diff=1.12 +/- 2.42, p=0.047, r=0.72) and PACT (diff=1.24 +/- 1.98, p=0.002, d=0.89). Conclusions: PACT, combined with DNS-based graded exercise, enhanced exercise motivation, perceived autonomy support, and adherence to exercise in patients with CLBP compared to UC. However, no significant improvements were observed in functioning or pain acceptance.

Citovat

NEVELIKOVA, Marketa; Filip ZLÁMAL; Filip DOSBABA; Jing Jing SU a Ladislav BAŤALÍK. Physiotherapy informed by acceptance and commitment therapy for chronic low back pain: A randomized trial. HONG KONG PHYSIOTHERAPY JOURNAL. SINGAPORE: WORLD SCIENTIFIC PUBL CO PTE LTD, 2026, roč. 46, č. 01, s. 15-28. ISSN 1013-7025. Dostupné z: https://doi.org/10.1142/S1013702526500022.

@article{2566802,
   author = {Nevelikova, Marketa and Zlámal, Filip and Dosbaba, Filip and Su, Jing Jing and Baťalík, Ladislav},
   article_location = {SINGAPORE},
   article_number = {01},
   doi = {https://doi.org/10.1142/S1013702526500022},
   keywords = {Acceptance and commitment therapy; chronic low back pain; exercise motivation; physiotherapy adherence; self-determination theory},
   language = {eng},
   issn = {1013-7025},
   journal = {HONG KONG PHYSIOTHERAPY JOURNAL},
   title = {Physiotherapy informed by acceptance and commitment therapy for chronic low back pain: A randomized trial},
   url = {https://www.worldscientific.com/doi/10.1142/S1013702526500022?srsltid=AfmBOopwQc3Ef5qTfbW7mO66dJ_DLS5_zhfDAbsjJn7gRrcHownFN--d},
   volume = {46},
   year = {2026}
}

TY  - JOUR
ID  - 2566802
AU  - Nevelikova, Marketa - Zlámal, Filip - Dosbaba, Filip - Su, Jing Jing - Baťalík, Ladislav
PY  - 2026
TI  - Physiotherapy informed by acceptance and commitment therapy for chronic low back pain: A randomized trial
JF  - HONG KONG PHYSIOTHERAPY JOURNAL
VL  - 46
IS  - 01
SP  - 15-28
EP  - 15-28
PB  - WORLD SCIENTIFIC PUBL CO PTE LTD
SN  - 10137025
KW  - Acceptance and commitment therapy
KW  - chronic low back pain
KW  - exercise motivation
KW  - physiotherapy adherence
KW  - self-determination theory
UR  - https://www.worldscientific.com/doi/10.1142/S1013702526500022?srsltid=AfmBOopwQc3Ef5qTfbW7mO66dJ_DLS5_zhfDAbsjJn7gRrcHownFN--d
N2  - Background: Chronic low back pain (CLBP) is a highly prevalent condition and a leading cause of disability worldwide. Given its complex etiology, there is growing interest in applying the biopsychosocial model to CLBP management in order to address psychological barriers - such as low motivation - that influence pain perception, exercise adherence, and overall treatment outcomes. Physiotherapy-informed Acceptance and Commitment Therapy (PACT) - a third-wave cognitive-behavioral approach - has shown promise in chronic pain management by promoting psychological flexibility and values-based action. Objective: The primary objective of this study is to evaluate patients' exercise motivation of PACT versus usual physiotherapy care (UC). Secondary objectives are to assess and compare the efficacy of PACT versus UC on functioning and disability, adherence to exercise, acceptance of pain and autonomy support from physiotherapists. Both interventions incorporated dynamic neuromuscular stabilization (DNS)-based graded exercise as a core physiotherapy approach. Methods: Fifty patients with CLBP participated in this study. All participants completed paper-and-pencil self-reported questionnaires to assess relevant outcome measures. Data were collected at two time points: baseline (prior to the first therapy session) and at week 6, immediately following the completion of the intervention period (post-intervention). Participants were randomly assigned to one of two groups. The PACT group received ACT-based physiotherapy combined with DNS-based graded exercise. The usual care (UC) group received individualized graded therapeutic exercise based on the DNS concept, complemented by manual therapy. Results: The PACT group showed significantly higher levels of exercise motivation compared to the UC group, with greater scores in introjected motivation (baseline: 4.15 +/- 1.56 versus 3.19 +/- 1.38, p=0.029, r=0.31; post-intervention: 4.49 +/- 1.05 versus 3.27 +/- 1.43, p=0.001, d=0.97) and identified motivation (post-intervention: 6.25 +/- 0.76 versus 5.35 +/- 1.31, p=0.015, r=0.35). Within-group comparisons revealed no significant changes in the UC group, whereas the PACT group demonstrated a decrease in external motivation (diff=-0.40 +/- 0.74, p=0.027, r=0.55) and increases in identified (diff=0.45 +/- 0.95, p<0.034, r=0.54) and intrinsic motivation (diff=0.80 +/- 1.13, p<0.001, r=0.76). Participants in the PACT group also reported significantly higher perceived autonomy support from the physiotherapist (6.52 +/- 0.54, p=0.027) than those in the UC group (5.86 +/- 0.90) (p=0.027, d=0.40). Furthermore, adherence to the recommended physical activity was significantly greater in the PACT group (18.96 +/- 3.17, p<0.001) compared with the UC group (13.32 +/- 2.58) (p<0.001, r=0.71). No statistically significant differences were observed between groups for measures of functioning and pain acceptance, however, both groups demonstrated significant within-group improvements. Disability decreased in UC (diff=-1.04 +/- 1.27, p=0.001, r=0.63) and PACT (diff=-1.08 +/- 2.10, p=0.018, r=0.63) while pain acceptance increased in UC (diff=1.12 +/- 2.42, p=0.047, r=0.72) and PACT (diff=1.24 +/- 1.98, p=0.002, d=0.89). Conclusions: PACT, combined with DNS-based graded exercise, enhanced exercise motivation, perceived autonomy support, and adherence to exercise in patients with CLBP compared to UC. However, no significant improvements were observed in functioning or pain acceptance.
ER  -

NEVELIKOVA, Marketa; Filip ZLÁMAL; Filip DOSBABA; Jing Jing SU a Ladislav BAŤALÍK. Physiotherapy informed by acceptance and commitment therapy for chronic low back pain: A randomized trial. \textit{HONG KONG PHYSIOTHERAPY JOURNAL}. SINGAPORE: WORLD SCIENTIFIC PUBL CO PTE LTD, 2026, roč.~46, č.~01, s.~15-28. ISSN~1013-7025. Dostupné z: https://doi.org/10.1142/S1013702526500022.

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