Cluster-Defined Response Patterns Following Pain Neuroscience Education With Physical Activity in Older Women With Chronic Low Back Pain: A Quasi-Randomized Exploratory Study.

BACKGROUND AND AIMS: To explore patterns of treatment response to pain neuroscience education combined with physical activity (PNE-PA) and to examine baseline characteristics associated with these patterns in older women with chronic low back pain (CLBP).

METHODS

In a community-based quasi-randomized trial, older women with CLBP were analyzed in a PNE-PA program (n = 43) or a biomechanical (BM) comparison group (n = 13). Physical function, physical activity (daily step counts by pedometer), pain intensity, disability, and pain-related psychological outcomes were assessed at baseline and 12 weeks. Between-group effects were examined using rank-based analysis of covariance adjusting for baseline values, age, and body mass index. Within the PNE-PA arm, k-means clustering on changes in 30-s chair-stand performance and pain catastrophizing (PCS) was used to identify response profiles, with baseline characteristics compared across clusters.

RESULTS

Compared with BM, PNE-PA produced larger adjusted improvements in chair-stand repetitions, daily step counts, and PCS scores; no significant between-group differences were observed for other outcomes. Three clusters were identified: minimal responders (n = 15), physical-function responders (n = 18), and psychological responders (n = 10). Physical-function responders showed greater chair-stand gains with lower baseline lower-limb function; psychological responders exhibited larger PCS reductions and lower baseline physical performance, together with higher PCS scores. Cluster separation was modest, and the gap statistic favored a single cluster, indicating descriptive, hypothesis-generating patterns.

CONCLUSION

Older women with CLBP receiving PNE-PA showed heterogeneous changes in physical function and pain-related cognitions. Lower baseline mobility and higher catastrophizing were associated with larger domain-specific improvements, although these associations may partly reflect regression to the mean. Identifying baseline physical and psychological profiles may inform more targeted group-based programs for older adults with CLBP.