Comparison of graded exercise and graded exposure clinical outcomes for patients with chronic low back pain.
Quasi-experimental clinical trial.This study compared outcomes from graded exercise and graded exposure activity prescriptions for patients participating in a multidisciplinary rehabilitation program for chronic low back pain.
Change in depressive symptoms was associated with change in pain intensity, while change in pain catastrophizing was associated with change in disability.Physical therapy supplemented with graded exercise or graded exposure resulted in equivalent clinical outcomes for pain intensity and disability.
The results showed decreasing levels of self-reported pain-related fear, pain intensity, disability, and improvements in physical activity level only when graded exposure in vivo was introduced, and not in the graded activity condition.
The treatment consisted of 8 individual VR graded exposure sessions.
What about the 20% it can't help?" Some patients, she believes, respond better to graded exposure therapy, in other words, by trying, bit by bit and in a managed way, to do the things that scare them most (40 years ago, anxiety and phobias were treated by means of "flooding", ie prolonged exposure to anxiety-inducing situations. Graded exposure therapy is a less brutal form of flooding).
In order to reduce pain-related fears and pain disability, graded exposure in vivo (GEXP) is likely to be an appropriate treatment.
They need to learn through their own experiences such as graded exposure, where they face something a little difficult, see they can handle it, then try something a bit harder still.
Individually tailored graded exposure in vivo (GEXP) has been demonstrated to reduce pain-related fear and increase functional abilities in patients with chronic low back pain, neck pain, and complex regional pain syndrome.
However, a gradually increased graded exposure from a low (3.2 dyn/cm2) to a high shear stress (19.6 dyn/cm2) resulted in a markedly reduced cell detachment, a highly elongated cell shape, and orientation or alignment of both cells and actin fibers, which were parallel to the direction of flow.
Graded exposure included specific activities that were feared due to back pain and was progressed with a hierarchical exposure paradigm.
