Background A biopsychosocial rehabilitation is recommended for chronic nonspecific low back pain (CNLBP); however, its effectiveness compared to the traditional supervised exercise therapy of CNLBP treatment is still unclear. Methods This was a parallel-group randomized controlled clinical trial. The sample consisted of 180 participants of both sexes, aged ≥18 years, with CNLBP for ≥3 months. Using web randomization and concealed allocation, they were assigned to three groups; graded activity receiving cognitive-behavioral therapy, group-based combined exercise therapy and education (GA; n = 59), supervised group-based combined exercise therapy and education (SET; n = 63), and a control group receiving usual care (n = 58). Interventions were administered for 4 weeks (8 sessions). The primary outcome was pain intensity. Outcome measures were collected baseline, after interventions (4 weeks), and during two follow-up periods (3 and 6 months). Results After the intervention, GA had a significant large effect on pain reduction compared to the control group (MD of 22.64 points; 95% CI = 16.10 to 29.19; p < 0.0001; Cohen’s d = 1.70), as well as SET compared with the control group (MD of 21.08 points; 95% CI = 14.64 to 27.52; p < 0.0001; Cohen’s d = 1.39), without significant difference between two intervention groups. At 3 and 6 months of follow-up, GA had a statistically significantly better effect in reducing pain, disability and fear-avoidance beliefs, and improving spinal extensor endurance, range of extension and quality of life compared to SET and the control group. A statistically significantly better effect of SET compared with the control group was found in reducing pain, disability, fear-avoidance beliefs, and improving the physical component of quality of life. Harms were not reported. Conclusion This study suggests that graded activity and group-based supervised exercise therapy have beneficial effects over the control group in the treatment of CNLBP. The graded activity was more beneficial than supervised group-based exercise therapy only during the follow-up. Trial registration Clinicaltrials.gov (NCT04023162; registration date: 17/07/2019).

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<abstract><sec> <title>Objectives</title> <p>To determine the prevalence and risk factors of spinal pain in the population of Bosnia and Herzegovina (BiH).</p> </sec><sec> <title>Methods</title> <p>This was a cross-sectional survey conducted online in November/December 2018. Participants were inhabitants of BiH of both sexes, aged ≥ 16 years. The sample was stratified based on region and demographic characteristics. Current pain was analyzed; point prevalence was measured.</p> </sec><sec> <title>Results</title> <p>We received 1048 responses, of which data from 1017 could be used. The prevalence of spinal pain in BiH was 70.9%: 75.5% in women (n = 440) and 64.7% in men (n = 281). Low back pain (LBP) was more common compared to neck pain (NP) and thoracic pain (TP) in both sexes and all age groups. Significant associations with spinal pain in the bivariate analysis were found for the following groups: women, aged from 30 to 50 years, with high school education, employed persons and retirees, spinal pain in parents, smoking, irregular physical activity, longer use of TV or computer/mobile phone per day.</p> </sec><sec> <title>Conclusion</title> <p>To our knowledge, this is the first study of the prevalence of spinal pain in BiH. Some factors associated with spinal pain are modifiable. Therefore, public health interventions should target those factors to reduce the burden of spinal pain in BiH.</p> </sec></abstract>

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Lumbalni bolni sindrom ili križobolju opisujemo kao pojavu boli, napetosti mišića i smanjenu funkcionalnu pokretljivost lumbalnog dijela kralježnice, pri kojem simptom boli može biti lokaliziran u lumbalnom dijelu kralježnice (vertebralni sindrom) ili se može širiti duž noge zbog uključenosti korjenova spinalnih živaca (vertebrogeni sindrom). Prema duljini trajanja simptoma razlikujemo: akutni oblik križobolje (simptomi prisutni do 6 tjedana), subakutni (simptomi prisutni od 6 do 12 tjedana) i kronični oblik (simptomi