INTRODUCTION
Although Acceptance and Commitment Therapy (ACT) has been shown to enhance pain acceptance and reduce depression symptoms in older adults with chronic pain, the long-term benefits remain inconclusive. This pilot cluster randomized controlled trial (RCT), featuring a double-blind design and embedded semi-structured interviews, evaluated the efficacy of a novel multimodal treatment approach (ACT plus exercise training; ACT+Ex) in improving self-reported pain-related outcomes and physical fitness among older adults with chronic low back pain (CLBP) at post-treatment and 6-month follow-up.
METHODS
Forty community-dwelling older adults (ages 62-85) with CLBP were randomized into two groups: ACT+Ex (n=20) or an Education plus Exercise program (Edu+Ex) (n=20). The treatment was delivered in group sessions over 8 weeks, with assessments conducted at baseline, post-treatment, and at the 6-month follow-up (primary endpoint). Self-reported outcomes included pain intensity, functional disability (measured by the Roland Morris Disability Questionnaire, RMDQ), psychological inflexibility (using the Acceptance and Action Questionnaire-Version 2, AAQ-II), health-related quality of life (EuroQol-5 Dimensions, EQ-5D-5L), and psychological well-being (measured by the Depression Anxiety Stress Scale). Physical fitness was assessed through various standardized tests. Repeated measures analysis of variance was conducted to evaluate the explore the potential effects of ACT on various clinical outcomes. Semi-structured interviews were conducted at 6-month post-treatment to understand the experiences of participants.
RESULTS
The trial achieved high recruitment eligibility (85.1%) and completion rates (92.5%). Results indicated that ACT+Ex significantly improved pain intensity, disability, psychological inflexibility, and health-related quality of life at both post-treatment and the 6-month follow-up. Notably, participants in the ACT+Ex group exhibited enhanced physical fitness (particularly in Timed Up and Go speed), while those in the Edu+Ex group showed no significant changes. Qualitative data analysis identified three superordinate themes: the impact of prior healthcare experiences on pain beliefs; acceptance strategies facilitating behavioral changes; and the facilitators and barriers to treatment compliance.
DISCUSSION
Our findings indicate promising results among older adults with CLBP. It underscores the necessity for a definitive RCT and provide a valuable foundation for future research into the behavioral mechanisms of ACT in clinical applications.