Background: Anxiety, depression, and pain-related fears are highly prevalent among individuals with chronic low back pain (CLBP). While aquatic therapy is a promising treatment modality for CLBP, its effects on psychological factors remain poorly understood.
Objective: To compare the effects of aquatic therapy (AT) versus standard care (SC) on psychological outcomes, pain, and disability in CLBP.
Methods: In this two-arm randomized controlled trial, 34 participants with CLBP were assigned to AT (n = 18) or SC (n = 16). Both groups received bi-weekly individual sessions over 10 weeks. Pain, disability, quality of life, anxiety, depression, pain catastrophizing, kinesiophobia, and sleep disturbance were assessed using the following validated questionnaires; Numerical Pain Rating Scale, Modified Oswestry Low Back Pain Disability Index, Short-Form 12 Item Survey Questionnaire, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia and Insomnia Severity Index, respectively.
Results: Mixed-design analysis of covariance revealed no significant group*time interactions for any outcomes (all p > 0.05). Both groups improved significantly in pain, disability, quality of life, pain catastrophizing, and anxiety (all p < 0.05). Only AT demonstrated significant reductions in kinesiophobia (p = 0.002) and sleep disturbance (p = 0.001).
Conclusions: Aquatic therapy may offer a more comfortable treatment alternative to address psychological factors associated with CLBP.
Clinical trial registration: www.clinicaltrials.gov identifier is NCT05823857.
Keywords: Aquatic therapy; chronic pain; low back pain; patient-reported outcomes; psychology; quality of life.
Low back pain is a disabling disease and a public health concern. Aquatic exercise is a promising therapy as it reduces weight on the spine, allowing exercise that may be challenging on land. Despite its benefits in improving pain, function and quality of life, the influence of aquatic therapy on the psychological factors of chronic low back pain are underexplored. Exploring this area could provide valuable insights into how aquatic therapy may help the mental burden of chronic low back pain, leading to better outcomes for patients. People with chronic low back pain were randomly placed in an aquatic exercise program or received the standard treatment for low back pain in an athletic therapy clinic. The programs were 10 weeks, twice per week and were supervised by athletic therapists. People reported their pain, functional level, quality of life, pain-related feelings, depression, anxiety and sleep quality using questionnaires before and after the program. Both aquatic therapy and standard treatment for low back pain showed improvements in pain, function, quality of life, and anxiety/depression. For pain-related feelings, both groups showed improvements in the way they think about their pain. However, only the aquatic therapy group showed an improvement in their fear of movement or physical activity. Furthermore, only the aquatic therapy group showed improvements in sleep quality. Overall, aquatic therapy may be a more comfortable treatment alternative to address mental factors associated with chronic low back pain. The data from this project will be used to design an accessible community program to better support individuals that desire to adopt healthier lifestyles.