INTRODUCTION: Recent efforts to augment exercise-based physical therapy programs with psychosocially informed treatments have become commonplace. Mindfulness meditation is one method that is becoming popularized as an accessory to physical therapy treatment for spine pain. The purpose of this study was to determine the effect of mindfulness video engagement on the neck and back disability in individuals undergoing exercise-based physical therapy for spine pain.

METHODS:  Individuals undergoing a 6-9 week of in-clinic exercise-based rehabilitation were offered enrollment in a 4-week video-based daily mindfulness meditation program on an online platform.  Home exercises were simultaneously provided on the same online platform. Low back- and neck-related disability assessed with the Oswestry Disability Index (ODI) and Neck Disability Index (NDI) were compared across no (0 videos), low (1-9 videos), medium (10-19 videos), and high (20-28 videos) engagement, using Analysis of Covariance correcting for age, body mass, and duration of symptoms. A separate model was generated to evaluate the influence of home exercise compliance on treatment outcomes. A receiver operating characteristic (ROC) curve was generated to identify a threshold for video engagement resulting in clinically significant reductions in disability (>10 points).

RESULTS:  A total of 342 individuals participated, with 23.3% (80) not engaging, 44.4% (152) with low engagement, 21% (72) with medium engagement, and 11.1% (38) with high engagement in mindfulness videos. Mean (SD) age was higher in the high engagement group compared to the no-engagement group (58 (15) vs 50 (18) years, p=0.031), as was duration of pain (118 (143) vs 63 (99) months, p=0.044). Body mass index (BMI) was greater in the low engagement group compared to the medium engagement group (27.9 (6) vs 25.6 (5) kg/m², p=0.035). There was a greater reduction in ODI in participants with high versus low engagement (-11(15) vs -4(10) points, p=0.012) in the adjusted model, while no significant group differences were observed for NDI (p=0.728). When controlling for home exercise completion, these differences were no longer significant(p>0.158).  A threshold of 10 videos was identified to predict a clinically important reduction in ODI, with a sensitivity of 46% and a specificity of 72%; AUC=0.59 (95%CI=.512-.665), p<0.05).

DISCUSSION:  Greater engagement in mindfulness videos is associated with larger reductions in low back-, but not neck-related disability in individuals undergoing exercise-based physical therapy for spine pain.  A minimum of 10 videos is recommended to achieve clinically important improvement. Home exercise completion may moderate the influence of mindfulness on ODI change.