Psychosocial Moderators and Mediators of Sensorimotor Exercise in Low Back Pain: A Randomized Multicenter Controlled Trial (original) (raw)
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Effects of an exercise program in individuals with chronic low back pain
2014
Introduction: Low back pain is a major cause of medical appointments, work disability and hospitalization. Aim: To measure changes in back pain scores and spinal functional capacity in individuals with low back pain after an exercise program. Methods: Non-randomized controlled trial of 40 participants (20 in the experimental group and 20 in the control group). Patients from both groups were evaluated before and after the program. The program consisted of flexibility training using joint mobilization and stretching exercises for the upper and lower limbs and back, as well as strength training for the abdominal muscles and hamstrings. Participants in the control group did not receive any exercise-related interventions, only medical care. Results: the experimental group showed significant improvements in pain score (P<0.001) and Oswestry functional capacity (P<0.001) at 5-week follow-up, whereas the control group had no significant differences. Final considerations: In this study...
2014
Introduction: Low back pain is a major cause of medical appointments, work disability and hospitalization. Aim: To measure changes in back pain scores and spinal functional capacity in individuals with low back pain after an exercise program. Methods: Non-randomized controlled trial of 40 participants (20 in the experimental group and 20 in the control group). Patients from both groups were evaluated before and after the program. The program consisted of flexibility training using joint mobilization and stretching exercises for the upper and lower limbs and back, as well as strength training for the abdominal muscles and hamstrings. Participants in the control group did not receive any exercise-related interventions, only medical care. Results: the experimental group showed significant improvements in pain score (P<0.001) and Oswestry functional capacity (P<0.001) at 5-week follow-up, whereas the control group had no significant differences. Final considerations: In this study...
Clinical Rehabilitation
Objective: To assess a comprehensive multicomponent intervention against a low intensity intervention for promoting physical activity in chronic low back pain patients. Design: Randomised controlled trial. Setting: Inpatient rehabilitation and aftercare. Subjects: A total of 412 patients with chronic low back pain. Interventions: A multicomponent intervention (Movement Coaching) comprising of small group intervention (twice during inpatient rehabilitation), tailored telephone aftercare (twice after rehabilitation) and internet-based aftercare (web 2.0 platform) versus a low level intensity intervention (two general presentations on physical activity, download of the presentations). Main measures: Physical activity was measured using a questionnaire. Primary outcome was total physical activity; secondary outcomes were setting specific physical activity (transport, workplace, leisure time) and pain. Comparative group differences were evaluated six months after inpatient rehabilitation. Results: At six months follow-up, 92 participants in Movement Coaching (46 %) and 100 participants in the control group (47 %) completed the postal follow-up questionnaire. No significant differences between the two groups could be shown in total physical activity (P = 0.30). In addition to this, workplace (P = 0.53), transport (P = 0.68) and leisure time physical activity (P = 0.21) and pain (P = 0.43) did not differ significantly between the two groups. In both groups, physical activity decreased during the six months follow-up.
Spine Surgery and Related Research, 2019
Introduction: Chronic low back pain (CLBP), defined as low back pain persisting for at least 3 months, leads to limitations in the activities of daily living and decreased quality of life. Individualized self-exercise education could be a preferable treatment option, especially in community-dwelling people with CLBP. Previous studies, however, did not directly compare the effects of therapist-led self-exercise education and material-only education, and there are only a few studies investigating the effects of low-dose (comprising a few sessions) self-exercise education on CLBP. We present a protocol of community-based, randomized study to evaluate the effects of low-dose (comprising a few sessions), therapist-led selfexercise education on CLBP. Methods: Forty-eight participants with CLBP (men and women, aged 40-74 years) will be allocated to therapeutic selfexercise education programs, either a therapist-led group (2-week therapist's consultation and material use) or material-only group (material use only), in a randomized controlled trial. Pain intensity (NRS, numeric rating scale), pain disability (RDQ, Roland-Morris disability questionnaire), pain self-efficacy (PSEQ, pain self-efficacy questionnaire), and quality of life score (EQ-5D, European quality of life-5 dimensions) will be measured at baseline and at 4, 12, and 24 weeks. We will apply a repeated-measures design with mixed-effect models to estimate group differences from the baseline.
BMC Musculoskeletal Disorders, 2013
Background In Germany, a multidisciplinary rehabilitation named “behavioural medical rehabilitation” (BMR) is available for treatment of chronic low back pain (clbp). A central component of BMR is standard exercise therapy (SET), which is directed mainly to improve physical fitness. There is a need to address psychosocial factors within SET and therefore to improve behavior change with a focus on the development of self-management skills in dealing with clbp. Furthermore, short-term effectiveness of BMR with a SET has been proven, but the impact of a behavioural exercise therapy (BET) for improvement of the long-term effectiveness of BMR is unclear. Methods/design To compare the effectiveness of two exercise programs with different approaches within BMR on the effects of BMR a prospective randomized controlled trial (RCT) in two rehabilitation centres will be performed. 214 patients aged 18–65 with clbp will be, based on an "urn randomisation"-algorithm, randomly assigned ...
Meta-Analysis: Exercise Therapy for Nonspecific Low Back Pain
Annals of Internal Medicine, 2005
Background: Exercise therapy is widely used as an intervention in low back pain. Objective: To evaluate the effectiveness of exercise therapy in adult nonspecific acute, subacute, and chronic low back pain versus no treatment and other conservative treatments. Data Sources: MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews. Study Selection: Randomized, controlled trials evaluating exercise therapy for adult nonspecific low back pain and measuring pain, function, return to work or absenteeism, and global improvement outcomes. Data Extraction: Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short-, intermediate-, and long-term follow-up. Data Synthesis: 61 randomized, controlled trials (6390 participants) met inclusion criteria: acute (11 trials), subacute (6 trials), and chronic (43 trials) low back pain (1 trial was unclear). Evidence suggests that exercise therapy is effective in chronic back pain relative to comparisons at all follow-up periods. Pooled mean improvement (of 100 points) was 7.3 points (95% CI, 3.7 to 10.9 points) for pain and 2.5 points (CI, 1.0 to 3.9 points) for function at earliest follow-up. In studies investigating patients (people seeking care for back pain), mean improvement was 13.3 points (CI, 5.5 to 21.1 points) for pain and 6.9 points (CI, 2.2 to 11.7 points) for function, compared with studies where some participants had been recruited from a general population (for example, with advertisements). Some evidence suggests effectiveness of a graded-activity exercise program in subacute low back pain in occupational settings, although the evidence for other types of exercise therapy in other populations is inconsistent. In acute low back pain, exercise therapy and other programs were equally effective (pain, 0.03 point [CI, ؊1.3 to 1.4 points]). Limitations: Limitations of the literature, including low-quality studies with heterogeneous outcome measures inconsistent and poor reporting, and possibility of publication bias. Conclusions: Exercise therapy seems to be slightly effective at decreasing pain and improving function in adults with chronic low back pain, particularly in health care populations. In subacute low back pain populations, some evidence suggests that a gradedactivity program improves absenteeism outcomes, although evidence for other types of exercise is unclear. In acute low back pain populations, exercise therapy is as effective as either no treatment or other conservative treatments.
Exercise and chronic low back pain: what works?
Pain, 2004
The aim of this review was to investigate current evidence for the type and quality of exercise being offered to chronic low back pain (CLBP) patients, within randomised controlled trials (RCTs), and to assess how treatment outcomes are being measured. A two-fold methodological approach was adopted: a methodological assessment identified RCTs of 'medium' or 'high' methodological quality. Exercise quality was subsequently assessed according to the predominant exercise used. Outcome measures were analysed based on current recommendations. Fifty-four relevant RCTs were identified, of which 51 were scored for methodological quality. Sixteen RCTs involving 1730 patients qualified for inclusion in this review based upon their methodological quality, and chronicity of symptoms; exercise had a positive effect in all 16 trials. Twelve out of 16 programmes incorporated strengthening exercise, of which 10 maintained their positive results at follow-up. Supervision and adequate compliance were common aspects of trials. A wide variety of outcome measures were used. Outcome measures did not adequately represent the guidelines for impairment, activity and participation, and impairment measures were over-represented at the expense of others. Despite the variety offered, exercise has a positive effect on CLBP patients, and results are largely maintained at follow-up. Strengthening is a common component of exercise programmes, however, the role of exercise co-interventions must not be overlooked. More high quality trials are needed to accurately assess the role of supervision and follow-up, together with the use of more appropriate outcome measures. q
Exercise as a treatment for chronic low back pain
The Spine Journal, 2004
BACKGROUND CONTEXT: Exercise is a widely prescribed treatment for chronic low back pain, with demonstrated effectiveness for improving function and work. PURPOSE: The goal of this article is to review several key aspects about the safety and efficacy of exercise that may help clinicians understand its utility in treating chronic back pain. STUDY DESIGN/SETTING: A computerized literature search of MEDLINE was conducted using "exercise," "fitness," "back pain," "backache" and "rehabilitation" as search words. Identified abstracts were scanned, and useful articles were acquired for further review. Additional references were acquired through the personal collections of research papers possessed by the authors and by reviewing prior review articles on this subject. These final papers were scrutinized for data relevant to the key aspects about exercise covered in this article. RESULTS: For people with acute, subacute or chronic low back pain, there is no evidence that exercise increases the risk of additional back problems or work disability. To the contrary, current medical literature suggests that exercise has either a neutral effect or may slightly reduce risk of future back injuries. Exercise can be prescribed for patients with chronic low back pain with three distinct goals. The first and most obvious goal is to improve or eliminate impairments in back flexibility and strength, and improve performance of endurance activities. There is a large body of evidence confirming that this goal can be accomplished for a majority of patients with chronic low back pain. The second goal of exercise is to reduce the intensity of back pain. Most studies of exercise have noted overall reduction in back pain intensity that ranges from 10% to 50% after exercise treatment. The third goal of exercise is to reduce back pain-related disability through a process of desensitization of fears and concerns, altering pain attitudes and beliefs and improving affect. The mechanisms through which exercise can accomplish this goal have been the subject of substantial research. CONCLUSIONS: Exercise is safe for individuals with back pain, because it does not increase the risk of future back injuries or work absence. Substantial evidence exists supporting the use of exercise as a therapeutic tool to improve impairments in back flexibility and strength. Most studies have observed improvements in global pain ratings after exercise programs, and many have observed that exercise can lessen the behavioral, cognitive, affect and disability aspects of back pain syndromes. Ć
Exercise and psychological factors in low back pain
Physical Activity Review
Pain is a complex and challenging problem for patients with low back pain and for the psychologists and physiotherapist. One of the most common musculoskeletal pain problems is low back pain. Literature data allow us to assume that possible cause of decreased multifidus size include reflex inhibition and disuse atrophy. Increased fatigability (decreased endurance) of the multifidus muscle has been demonstrated in low back pain (LBP) patients in several research studies. Taking up physical activity belongs to one of the fundamentals of the therapy Formal exercise programmes used in conjunction with other methods of treatment and psychological therapy are one the main forms treatments in low back pain. Lifestyle, physical activity in particular is one on the factors influencing the health of youth and adults. Passiveness and apathy do not facilitate the persistence in realizing the aims of treatment.