Evidence map›Paper›PMID 41968847›Full record

Trial reportPain research & management2026

Effects of Therapeutic Aquatic Exercise Versus Physical Therapy Modalities on Pain and Disability in People With Chronic Low Back Pain: Potential Mediating Roles of Kinesiophobia, Anxiety, and Depression.

Shengfeng Liu, Yanan Zheng, Changcheng Chen, Juan Wang, Mengsi Peng

Abstract readRandomized Controlled Trial
In one paragraph

Trial report in Pain research & management, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Trial
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Shengfeng LiuDepartment of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical University, Haikou, China, hainmc.edu.cn.ORCID https://orcid.org/0009-0009-7235-3626
Yanan ZhengDepartment of Rehabilitation Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China, ahmu.edu.cn.ORCID https://orcid.org/0000-0001-9958-9844
Changcheng ChenDepartment of Rehabilitation Medicine, Qingtian People's Hospital, Lishui, China, moh.gov.my.ORCID https://orcid.org/0000-0003-0248-4072
Juan WangDepartment of Rehabilitation Medicine, Changzhou Seventh People's Hospital, Jiangsu Changzhou, China, moh.gov.my.ORCID https://orcid.org/0000-0002-6041-5449
Mengsi PengDepartment of Rehabilitation Therapy, The Second Affiliated Hospital of Hainan Medical University, Haikou, China, hainmc.edu.cn.ORCID https://orcid.org/0000-0001-6229-767X

Funding

Health Science & Technology Innovation of Hainan Province WSJK2024QN114
6 · The paper itself

Abstract

objectiveTo examine whether kinesiophobia, anxiety, and depression mediate the effects of therapeutic aquatic exercise (TAE) versus physical therapy modalities (PTMs) on pain and disability in patients with chronic low back pain (CLBP).

methodsThis study was a secondary analysis of data derived from a previously conducted randomized controlled trial, applying mediation analysis to explore potential psychological mediators. A total of 113 participants received 60-min sessions of TAE or PTMs twice weekly for 3 months. The Roland-Morris Disability Questionnaire (RMDQ) and the numeric rating scale (NRS) were employed to measure the main outcome; the mediators included the Tampa Scale for Kinesiophobia (TSK), the Self-Rating Anxiety Scale (SAS), and the Zung Self-Rating Depression Scale (SDS). All mediation models reported causal pathway parameters, including intervention-mediator and mediator-outcome coefficients, with decomposition of total effect into direct and indirect effect (IE).

resultsThe mediation analysis found that kinesiophobia and depression mediated the effects of TAE compared with PTMs on the average pain (TSK [IE -0.203, 95% confidence interval, CI, -0.467 to -0.025]; SDS [IE -0.173, 95% CI -0.426 to -0.010]), the current pain (TSK [IE -0.151, 95% CI -0.371 to -0.013]; SDS [IE -0.220, 95% CI -0.495 to -0.030]), and the most severe pain (SDS [IE -0.186, 95% CI -0.476 to 0.004]) at 12 months. Meanwhile, kinesiophobia and depression mediated the TAE intervention effects on disability at 12 months (TSK [IE -0.174, 95% CI -2.176 to -0.270]; SDS [IE -0.555, 95% CI -1.470 to -0.014]). Anxiety mediated the effect of TAE on disability at 3 months (IE -0.365, 95% CI -0.832 to -0.065).

conclusionKinesiophobia, anxiety, and depression mediated noticeable improvements in pain and disability for patients with CLBP when conducting TAE intervention.

trial registrationChinese Registry of Clinical Trial: ChiCTR1800016396.

Indexed as

AnxietyChronic PainDepressionExercise TherapyKinesiophobiaLow Back PainPhysical Therapy ModalitiesAdultDisability EvaluationFemaleHumansMaleMiddle AgedPain MeasurementTreatment Outcomeanxietydepressionkinesiophobialow back paintherapeutic aquatic exercise

Identifiers

PMID41968847
PMCPMC13071334

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.