Evaluation of a specific home exercise program for low back pain. A Randomized, Controlled Trial of Manual Therapy and Specific Adjuvant Exercise for Chronic Low Back Pain Effect of Motor Control Exercises Versus Graded Activity in Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome Effects of preferred-exercise prescription compared to usual exercise prescription on outcomes for people with non-specific low back pain: a randomized controlled trial [ACTRN12608000524392] A walking programme and a supervised exercise class versus usual physiotherapy for chronic low back pain: a single-blinded randomised controlled trial. (The Supervised Walking In comparison to Fitness Training for Back Pain (SWIFT) Trial) Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain.
BACKGROUND The prescription of exercise as a conservative treatment for lumbar pain is frequent and seems effective for the chronic cases of nonspecific low back pain . However , there is no evidence favoring one type of exercise over another . Often , exercise programs are prescribed without adequate evaluation of the individual characteristics like posture , muscular force , and extensibility . Patients with totally different causes of low back pain will often be given the same type of exercises . OBJECTIVE Our objective was to compare the effectiveness of 2 home exercise programs in decreasing disability and pain related to subacute and chronic nonspecific low back pain . To do so we compared a specific ( individualized ) exercise program with a program of commonly prescribed exercises for low back pain . METHOD In a control group study , 20 patients with chronic or subacute nonspecific low back pain participated after giving their informed consent . All subjects were evaluated ( physical evaluation of lumbar and pelvic muscles [ 1 ] force and [ 2 ] extensibility , [ 3 ] trunk range of motion ) and then divided in 2 groups : 10 patients received specific exercises ( experimental group ) based on their evaluation , and 10 patients received a commonly prescribed exercise program for low back pain ( control group ) . Six weeks later a second physical evaluation was conducted . Pain ( visual analog pain scale ) and disability ( modified Oswestry ) question naires were also completed by each subject at both evaluations . DESIGN This was a r and omized experimental study . RESULTS Both groups had similar age , weight , and sex characteristics . The experimental group showed significant improvements for some components targeted by the program . The control group significantly had improvement of some physical characteristics not related to their initial deficits . Even if both groups showed some improvements in muscular force and extensibility , only the members of the group who received specific exercises significantly reduced their level of pain and disability . Both groups showed a similar rate of participation in the program . CONCLUSION The results of this study suggest that applying a specific physical evaluation and exercise prescription is an appropriate treatment for people having subacute or chronic nonspecific pain . Thus clinicians should prescribe exercise programs based on individual muscular deficits rather than most commonly prescribed exercise programs Objective : This article examines the effectiveness of manual therapy with specific adjuvant exercise for treating  chronic low back pain and disability .  Methods : A single blind , r and omized , controlled trial was employed . Patients were prescribed an exercise program that was tailored to treat their musculoskeletal dysfunctions or given a nonspecific program of general stretching and aerobic conditioning . In addition , patients received manual therapy or sham manual therapy . Participants were seen for 6 weekly sessions and were asked to perform their exercise program twice daily . Results : Seventy-two out of 100 patients completed the study . Multivariate tests conducted for measures of pain and disability revealed a significant group by time interaction ( P = 0.04 and P = 0.05 , respectively ) , indicating differential change in these measures pretreatment to posttreatment as a function of the treatment received . When controlling for pretreatment scores , patients receiving manual therapy with specific adjuvant exercise reported significant reductions in pain . No change in perceived disability was observed , with the exception that patients receiving sham manual therapy with specific adjuvant exercise reported significantly greater disability at posttreatment . Discussion : Manual therapy with specific adjuvant exercise appears to be beneficial in treating  chronic low back pain .  Despite changes in pain , perceived function did not improve . It is possible that impacting chronic low back pain alone does not address psychosocial or other factors that may contribute to disability . Further studies are needed to examine the long-term effects of these interventions and to address what adjuncts are beneficial in improving function in this population Background Motor control exercises to improve control and coordination of trunk muscles and grade d activity under the principles of cognitive-behavioral therapy are 2 commonly used exercise therapies , yet there is little evidence to support the use of one intervention over the other . Objective The objective of this study was to compare the effectiveness of motor control exercises and grade d activity for patients with chronic nonspecific low back pain . Design This study was a prospect ively registered r and omized controlled trial with outcome assessment and statistical analyses conducted blind to group . Setting The study was conducted in primary care setting s. Patients The participants were 172 patients with chronic ( > 12 weeks ) nonspecific low back pain . Interventions Patients were r and omly assigned to receive either motor control exercises or grade d activity . There was no attempt to subclassify patients to match them to a treatment . Patients in both groups received 14 sessions of individualized , supervised exercise therapy . Measurements Primary outcomes were average pain over the previous week ( numeric rating scale ) and function ( Patient-Specific Functional Scale ) ; secondary outcomes were disability ( 24-item Rol and -Morris Disability Question naire ) , global impression of change ( Global Perceived Effect Scale ) , and quality of life ( 36-Item Short-Form Health Survey question naire [ SF-36 ] ) . Outcome measures were collected at baseline and at 2 , 6 , and 12 months after intervention . Results A linear mixed models analysis showed that there were no significant differences between treatment groups at any of the time points for any of the outcomes studied . For example , the effect for pain at 2 months was 0.0 ( −0.7 to 0.8 ) . Limitations Clinicians could not be blinded to the interventions . Conclusion The results of this study suggest that motor control exercises and grade d activity have similar effects for patients with chronic nonspecific low back pain Exercise rehabilitation is one of the few evidence -based treatments for chronic non-specific low back pain ( cLBP ) , but individual success is notoriously variable and may depend on the patient ’s adherence to the prescribed exercise regime . This prospect i ve study examined factors associated with adherence and the relationship between adherence and outcome after a programme of physiotherapeutic spine stabilisation exercises .  A total of 32/37 patients with cLBP completed the study ( mean age , 44.0 ( SD = 12.3 ) years ; 11/32 ( 34 % ) male ) . Adherence to the 9-week programme was documented as : percent attendance at therapy , percent adherence to daily home exercises ( patient diary ) and percent commitment to rehabilitation ( Sports Injury Rehabilitation Adherence Scale ( SIRAS ) ) . The average of these three measures formed a multidimensional adherence index ( MAI ) . Psychological disturbance , fear-avoidance beliefs , catastrophising , exercise self-efficacy and health locus of control were measured by question naire ; disability in everyday activities was scored with the Rol and –Morris disability scale and back pain intensity with a 0–10 graphic rating scale . Overall , adherence to therapy was very good ( average MAI score , 85 % ; median ( IQR ) , 89 (15)% ) . The only psychological/beliefs variable showing a unique significant association with MAI was exercise self-efficacy ( Rho = 0.36 , P = 0.045 ) . Pain intensity and self-rated disability decreased significantly after therapy ( each P < 0.01 ) .  Adherence to home exercises  showed a moderate , positive correlation with the reduction in average pain ( Rho = 0.54 , P = 0.003 ) and disability ( Rho = 0.38 , P = 0.036 ) ; higher MAI scores were associated with greater reductions in average pain ( Rho = 0.48 , P = 0.008 ) and a ( n.s . ) tendency for greater reductions in disability ( Rho = 0.32 , P = 0.07 ) Neither attendance at therapy nor SIRAS were significantly related to any of the outcomes . The benefits of rehabilitation depended to a large extent on the patient ’s exercise behaviour outside of the formal physiotherapy sessions . Hence , more effort should be invested in finding ways to improve patients ’ motivation to take responsibility for the success of their own therapy , perhaps by increasing exercise self-efficacy . Whether the “ adherence– outcome ” interaction was mediated by improvements in function related to the specific exercises , or by a more “ global ” effect of the programme , remains to be examined Background Non-specific chronic low back pain ( NSCLBP ) has become a significant problem due to high healthcare utilization , rising costs of care and perceived limitations of effectiveness of many current treatments . Systematic review s have repeatedly concluded that , on average across participants , exercise for NSCLBP appears effective in decreasing pain and improving function . Not all people with NSCLBP benefit from exercise programs and it would assist care-providers and care-seekers if factors that impact on program effectiveness and success were identified . Methods and design The study will be a r and omised controlled trial comparing an exercise rehabilitation program informed by a participant preferences question naire compared to a program without this guideline for patients with chronic low back pain . A sample of 150 patients will be recruited in Melbourne , Australia through community-based healthcare clinics that provide supervised exercise rehabilitation programs for people with non-specific chronic low back pain . Clinicians will be r and omly assigned to exercise preferences question naire or no question naire and participants will be allocated in a concealed manner . A qualitative focus group study of exercise instructor feedback about the exercise preferences instrument will be embedded in the research design . Two qualitative focus group studies will also be conducted for participants in the intervention and the control groups to obtain feedback about participants ' experiences of the two types of exercise programs . The primary outcomes will be functional ability , pain , fear avoidance , exercise adherence . Discussion This trial will evaluate the effectiveness of individualised exercise prescription compared to usual exercise prescription for NSCLP and , using feedback following the trial , refine the exercise preferences question naire Background Chronic low back pain ( CLBP ) is a persistent disabling condition with rising significant healthcare , social and economic costs . Current research supports the use of exercise-based treatment approaches that encourage people with CLBP to assume a physically active role in their recovery . While international clinical guidelines and systematic review s for CLBP support supervised group exercise as an attractive first-line option for treating large numbers of CLBP patients at low cost , barriers to their delivery include space and time restrictions in healthcare setting s and poor patient attendance . The European Clinical Guidelines have identified the need for research in the use of brief/minimal contact self-activation interventions that encourage participation in physical activity for CLBP . Walking may be an ideally suited form of individualized exercise prescription as it is easy to do , requires no special skills or facilities , and is achievable by virtually all ages with little risk of injury , but its effectiveness for LBP is unproven . Methods and design This study will be an assessor-blinded r and omized controlled trial that will investigate the difference in clinical effectiveness and costs of an individualized walking programme and a supervised general exercise programme compared to usual physiotherapy , which will act as the control group , in people with chronic low back pain . A sample of 246 patients will be recruited in Dublin , Irel and through acute general hospital outpatient physiotherapy departments that provide treatment for people with CLBP . Patients will be r and omly allocated to one of the three groups in a concealed manner . The main outcomes will be functional disability , pain , quality of life , fear avoidance , back beliefs , physical activity , satisfaction and costs , which will be evaluated at baseline , and 3 , 6 and 12 months [ follow-up by pre-paid postage ] . Qualitative telephone interviews and focus groups will be embedded in the research design to obtain feedback about participants ' experiences of the interventions and trial participation , and to inform interpretation of the quantitative data . Planned analysis will be by intention to treat ( quantitative data ) and thematic analysis ( qualitative data ) Discussion The trial will evaluate the effectiveness of a walking programme and a supervised general exercise programme compared to usual physiotherapy in people with CLBP.Trial registration Current controlled trial IS RCT BACKGROUND AND PURPOSE The purpose of this r and omized controlled trial was to examine the usefulness of the addition of specific stabilization exercises to a general back and abdominal muscle exercise approach for patients with subacute or chronic nonspecific back pain by comparing a specific muscle stabilization-enhanced general exercise approach with a general exercise-only approach . SUBJECTS Fifty-five patients with recurrent , nonspecific back pain ( stabilization-enhanced exercise group : n=29 , general exercise-only group : n=26 ) and no clinical signs suggesting spinal instability were recruited . METHODS Both groups received an 8-week exercise intervention and written advice ( The Back Book ) . Outcome was based on self-reported pain ( Short-Form McGill Pain Question naire ) , disability ( Rol and -Morris Disability Question naire ) , and cognitive status ( Pain Self-Efficacy Question naire , Tampa Scale of Kinesiophobia , Pain Locus of Control Scale ) measured immediately before and after intervention and 3 months after the end of the intervention period . RESULTS Outcome measures for both groups improved . Furthermore , self-reported disability improved more in the general exercise-only group immediately after intervention but not at the 3-month follow-up . There were generally no differences between the 2 exercise approaches for any of the other outcomes . DISCUSSION AND CONCLUSION A general exercise program reduced disability in the short term to a greater extent than a stabilization-enhanced exercise approach in patients with recurrent nonspecific low back pain . Stabilization exercises do not appear to provide additional benefit to patients with subacute or chronic low back pain who have no clinical signs suggesting the presence of spinal instability
Participants believed that there were distinctions between general activity , real/fitness exercise , and medical exercise .
People participating in exercise classes and group work may be more comfortable when matched for abilities and experience .
When an intervention interferes with everyday life and appears to be ineffective or too difficult to implement , people make a reasoned decision to discontinue .
DISCUSSION People are likely to prefer and participate in exercise or training programs and activities that are design ed with consideration of their preferences , circumstances , fitness levels , and exercise experiences
OBJECTIVES The global burden of low back pain is the highest ranked condition contributing to years of living with disability .
Exercise is moderately effective , and adherence to exercise may improve if participants are engaged .
Identification of elements that enhance engagement would enable clinicians to prescribe appropriate interventions .
The review objective was to identify and synthesize qualitative empirical studies that have explored beliefs about exercise therapy of people with nonspecific chronic low back pain .