Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences

Moffett, Jennifer Klaber; Torgerson, David; Bell-Syer, Sally EM; Jackson, David A.; Llewlyn-Phillips, Hugh; Farrin, Amanda; Barber, Julie

doi:10.1136/bmj.319.7205.279

Cited by 340 publications

(190 citation statements)

References 21 publications

(23 reference statements)

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“…The cost-effectiveness of home exercises as well as group exercises is confirmed in the literature (Frost et al 1995, Moffett et al 1999. It appears that while most physiotherapists in this study prescribe home exercises, few make use of group exercise classes, which could also save time for the physiotherapist (Moffett et al 1999).…”

Section: Discussionsupporting

confidence: 61%

“…It appears that while most physiotherapists in this study prescribe home exercises, few make use of group exercise classes, which could also save time for the physiotherapist (Moffett et al 1999). Two of the deterrents to conducting exercise classes were the financial disadvantages of low medical aid tariffs for group classes and '... the physical need for space' in which to provide group exercises.…”

Section: Discussionmentioning

confidence: 99%

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Private practitioners`use of exercise therapy in lower back pain

Strydom

Faure

Bester

2005

South African Journal of Physiotherapy

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Private practitioners`use of exercise therapy in lower back pain

Strydom

Faure

Bester

2005

South African Journal of Physiotherapy

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“…One explanation might be that patients who underwent lumbar disc surgery are different from patients with chronic low back pain. For example, RDQ scores at baseline in the current study are relatively high compared to recent studies that include patients with chronic low back pain, 43,44 indicating a more severe degree of disability. Furthermore, although the majority OF patients in the current study had suffered symptoms for more than 3 months (83% and 87%, respectively, in UC and BGA) and are, therefore, usually labeled as chronic, the period after the operation might be more important to classify these patients.…”

Section: Can Postsurgery Patients Be Considered As Chronic Pain Patiementioning

confidence: 82%

Behavioral Graded Activity Following First-Time Lumbar Disc Surgery

Ostelo¹,

Vet

Vlaeyen³

et al. 2003

Spine

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Study Design and Objectives. In a randomized clinical trial, the effectiveness of behavioral graded activity was assessed as compared to usual care provided by physiotherapists for patients after first-time lumbar disc surgery (n ϭ 105).Summary of Background Data. Little is known about the effectiveness of rehabilitation programs following lumbar disc surgery. Most programs focus on biomechanical aspects, whereas psychosocial factors are hardly addressed. The aim of the behavioral graded activity program, which is an operant treatment, is to alter psychosocial factors such as fear of movement and pain catastrophizing, which might subsequently lead to improved functional status and higher rates of recovery. Behavioral treatments for patients following lumbar disc surgery have not yet been assessed in a randomized clinical trial.Methods. Inclusion criteria: age between 18 and 65 years; first-time lumbar disc surgery; restrictions in normal activities of daily living. Exclusion criteria: surgical complications and confirmed and relevant underlying diseases. Outcome assessment took place at 6 and 12 months after randomization.Results. Six months after randomization, 62% of the patients had recovered following usual care versus 65% of the patients following behavioral graded activity. After 12 months, 73% and 75%, respectively, had recovered. Differences between intervention groups, 3% and 2% respectively, after 6 and 12 months are not statistically significant. Furthermore, there were no differences between the two groups regarding functional status, pain, pain catastrophizing, fear of movement, range of motion, general health, social functioning or return to work. After 1 year, 4 of the behavioral graded activity cases had undergone another operation versus 2 of usual care cases.Conclusion. Both fear of movement and pain catastrophizing seem to be unaffected by either treatment in these patients. It is concluded that treatment principles derived from theories within the field of chronic low back pain might not apply to these patients. After 1 year of follow-up, there were no statistically significant or clinically relevant differences between the behavioral graded activity program and usual care as provided by physiotherapists for patients following first-time lumbar disc surgery.

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“…Indeed, 85% of patients recover within a few months and do not really require even diagnostic imaging (32). Programs incorporating exercise seem to have better outcomes (33). Injured workers who stopped exercising after a back injury had longer periods of disability than those who remained more physically active (34).…”

Section: Discussionmentioning

confidence: 99%