ABSTRACT
BACKGROUND: Adherence to an exercise programme impacts the outcome of physiotherapy treatment in patients with non-specific low back pain. OBJECTIVES: The aim of this study was to explore the patients' perspectives on long term adherence to such exercise programmes. DESIGN: This qualitative study was embedded in a randomised controlled trial (RCT) which compared the effectiveness of two types of exercise programme on patients with nonspecific low back pain. METHODS: Answers from 44 participants to three open-ended questions were analysed using thematic analysis. RESULTS/FINDINGS: Patients' perceptions related to the following themes: 1) the role of knowledge in long-term exercise adherence; 2) strategies to support exercise adherence; 3) barriers to exercise adherence 4) the role of perceived effects of exercise. CONCLUSIONS: Adherence to long-term exercise is supported through knowledge of the exercises and correct performance. A self-initiated training strategy is the most successful in the perception of participants. Individually supervised physiotherapy treatment that includes coaching towards strategies for post-treatment long term exercise behaviour is recommended.
Subject(s)
Chronic Disease/psychology , Chronic Disease/therapy , Exercise Therapy/psychology , Low Back Pain/therapy , Patient Compliance/psychology , Patient Compliance/statistics & numerical data , Physical Therapy Modalities/psychology , Self Care/psychology , Adult , Aged , Female , Home Care Services , Humans , Male , Middle Aged , Qualitative ResearchABSTRACT
BACKGROUND: Exercise is an effective treatment for patients with sub-acute and chronic low back pain (LBP). Patients with a movement control impairment (MCI) can be diagnosed as a subgroup of patients with LBP. Unknown is which exercise intervention is most beneficial for this subgroup. This study assessed the short-term effect of a specific exercise program targeting movement control impairment versus general exercise treatment on disability in patients with LBP and MCI. METHODS: In a multicentre parallel group randomised controlled pragmatic trial, patients with sub-acute and chronic LBP were included. Further inclusion criteria were disability of ≥5 points on the Roland-Morris Disability Questionnaire and ≥2 positive tests out of a set of 6 movement control impairment tests. A total of 106 patients were randomly assigned to either tailored movement control exercise intervention (MC, n = 52) or a general exercise intervention (GE, n = 54); both 9-18 individual treatment sessions, over a maximum of 12 weeks. The primary outcome was disability measured with the Patient Specific Functional scale (PSFS). Secondary outcome was the Roland-Morris disability scale (RMDQ). Measurements were taken pre- and posttreatment. RESULTS: No significant difference was found following the treatment period. Baseline-adjusted between-group mean difference for the PSFS was 0.5 (SD = 0.5; p = 0.32) in favour of MC exercises. The Roland-Morris Disability Questionnaire revealed a significant, but not clinically relevant, between-group difference of 2.0 points (SD = 0.8; p = 0.01). CONCLUSION: Disability in LBP patients was reduced considerably by both interventions. However, the limited contrast between the two exercise programs may have influenced outcomes.
Subject(s)
Disability Evaluation , Exercise Therapy/methods , Low Back Pain/rehabilitation , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Pain Measurement , Single-Blind Method , Young AdultABSTRACT
BACKGROUND: Exercise is an effective treatment for patients with sub-acute and chronic non-specific low back pain (NSLBP). Previous studies have shown that a subgroup of patients with NSLBP and movement control impairment (MCI) can be diagnosed with substantial reliability. However, which type of exercises are most beneficial to this subgroup is still unknown. OBJECTIVES: The effectiveness of a specific exercise treatment to improve movement control was tested in this study. METHODS: Using a multicentre randomised controlled trial (RCT), we compared exercises that targeted MCI (MC) with a general exercise (GE) treatment. After randomisation, patients in both groups n(MC = 52; GE = 54) were treated in eight private physiotherapy practices and five hospital outpatient physiotherapy centres. Follow-up measurements were taken at post-treatment, six months and 12 months. The primary outcome measurement was the Patient Specific Function Scale (PSFS). RESULTS: PSFS showed no difference between groups after treatment, or at six months and 12 months. Secondary outcome analysis for pain and disability, measured with the Graded Chronic Pain scale and the Roland Morris Disability Questionnaire respectively, showed that a small improvement post-treatment levelled off over the long term. Both groups improved significantly (p < 0.001) over the course of one year. CONCLUSION: This study found no additional benefit of specific exercises targeting MCI.
Subject(s)
Exercise Therapy/organization & administration , Exercise/physiology , Low Back Pain/rehabilitation , Musculoskeletal Pain/rehabilitation , Adult , Age Factors , Aged , Ambulatory Care/organization & administration , Analysis of Variance , Chronic Pain/rehabilitation , Disability Evaluation , Female , Follow-Up Studies , Humans , Low Back Pain/diagnosis , Male , Middle Aged , Musculoskeletal Pain/diagnosis , Norway , Risk Factors , Sex Factors , Single-Blind Method , Switzerland , Time Factors , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Non-specific low back pain (NSLBP) in subacute and chronic stages can be treated effectively with exercise therapy. Research guidelines recommend evaluating different treatments in defined subgroups of patients with NSLBP. A subgroup of patients with movement control impairment (MCI) improved significantly on patient specific function and disability in a previous case series after movement control exercises. METHODS/DESIGN: In a randomised controlled trial (RCT) we will compare the effectiveness of movement control and general exercise in patients with MCI. 106 participants aged 18 - 75 will be recruited in 5 outpatient hospital departments and 7 private practices.Patients randomly assigned to the movement control exercise group will be instructed to perform exercises according to their MCI. The general exercise group will follow an exercise protocol aimed at improving endurance and flexibility. Patients in both groups will receive 9 - 18 treatments and will be instructed to do additional exercises at home.The primary outcome is the level of disability assessed using the patient specific functional scale (PSFS) which links the perceived pain to functional situations and is measured before treatment and at 6 and 12 months follow-up. Secondary outcomes concern low back pain related disability (Roland Morris questionnaire, RMQ), graded chronic pain scale (GCPS), range of motion and tactile acuity. DISCUSSION: To our knowledge this study will be the first to compare two exercise programs for a specific subgroup of patients with NSLBP and MCI. Results of this study will provide insight into the effectiveness of movement control exercise and contribute to our understanding of the mechanisms behind MCI and its relation to NSLBP. TRIAL REGISTRATION: Current Controlled Trials ISRCTN80064281.
