Motor Control Exercise for Chronic Low Back Pain: A Randomized Placebo-Controlled Trial

Musculoskeletal Division, The George Institute for International Health, Sydney, New South Wales 2050, Australia.
Physical Therapy (Impact Factor: 2.53). 11/2009; 89(12):1275-86. DOI: 10.2522/ptj.20090218
Source: PubMed


The evidence that exercise intervention is effective for treatment of chronic low back pain comes from trials that are not placebo-controlled.
The purpose of this study was to investigate the efficacy of motor control exercise for people with chronic low back pain.
This was a randomized, placebo-controlled trial.
The study was conducted in an outpatient physical therapy department in Australia. Patients The participants were 154 patients with chronic low back pain of more than 12 weeks' duration.
Twelve sessions of motor control exercise (ie, exercises designed to improve function of specific muscles of the low back region and the control of posture and movement) or placebo (ie, detuned ultrasound therapy and detuned short-wave therapy) were conducted over 8 weeks.
Primary outcomes were pain intensity, activity (measured by the Patient-Specific Functional Scale), and patient's global impression of recovery measured at 2 months. Secondary outcomes were pain; activity (measured by the Patient-Specific Functional Scale); patient's global impression of recovery measured at 6 and 12 months; activity limitation (measured by the Roland-Morris Disability Questionnaire) at 2, 6, and 12 months; and risk of persistent or recurrent pain at 12 months.
The exercise intervention improved activity and patient's global impression of recovery but did not clearly reduce pain at 2 months. The mean effect of exercise on activity (measured by the Patient-Specific Functional Scale) was 1.1 points (95% confidence interval [CI]=0.3 to 1.8), the mean effect on global impression of recovery was 1.5 points (95% CI=0.4 to 2.5), and the mean effect on pain was 0.9 points (95% CI=-0.01 to 1.8), all measured on 11-point scales. Secondary outcomes also favored motor control exercise. Limitation Clinicians could not be blinded to the intervention they provided.
Motor control exercise produced short-term improvements in global impression of recovery and activity, but not pain, for people with chronic low back pain. Most of the effects observed in the short term were maintained at the 6- and 12-month follow-ups.

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    • "Who is suitable for getting benefits from a stabilization program? This sort of program has shown to produce short-term improvements in global impression of recovery and activity for people with chronic low back pain, maintaining the results after 6 and 12 months (Costa et al., 2009), as well as be superior to minimal intervention at long term follow-up (Macedo et al., 2009; Kriese, 2010). Improvements in pain intensity and functional disability were also demonstrated in groups of patients with low back pain suffering from a spondylolisis or a spondylolisthesis (O'Sullivan, 2000) and a significant decrease of symptoms in people with hypermobility (Fritz et al., 2005). "

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    • "According to previous authors, this mechanism leads to a tissue overload and mechanically provoked pain (Dankaerts et al 2007, O'Sullivan 2005). Impairment-specific exercises for movement awareness and control of the lumbopelvic region are effective for patients with NSLBP and movement control impairment (Costa et al 2009, Macedo et al 2012). However, traditional exercises are often considered monotonous, which leads to discontinuation, particularly at home (Burke et al 2009, Duncan et al 2002, Becker 1985). "
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    ABSTRACT: Specific exercises for the improvement of movement control of the lumbopelvic region are well-established for patients with non-specific low back pain (NSLBP) and movement control impairment (MCI). However, a lack of adherence to home exercise regimens is often observed. The aim of the study was to explore the differences in home exercise (HE) adherence between patients who perform conventional exercises and those who exercise with Augmented Feedback (AF). Twenty patients with NSLBP and MCI were randomly allocated into two groups. The physiotherapy group (PT group) completed conventional exercises, and the AF group exercised with an AF system that was designed for use in therapy settings. The main outcome measure was self-reported adherence to the home exercise regimen. There was no significant difference in HE duration between the groups (W= 64, p= 0.315). The AF group exercised for a median of 9 min and 4 s (IQR= 3’59’’), and the PT group exercised for 4 min and 19 s (IQR= 8’30’’). Exercising with AF led to HE times that were similar to those of conventional exercise, and AF might be used as an alternative therapy method for home exercise.
    Journal of Bodywork and Movement Therapies 01/2015; 19(1):177-85. DOI:10.1016/j.jbmt.2014.11.017
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    • "30 minute class, twice a week for 8 weeks. 2. General exercise Costa 2009 [68] 154 patients recruited from a physical therapy department of an Australian hospital (mean age = 53.7/79% male). "
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    ABSTRACT: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise. A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate. 29 studies were included: 22 studies (n = 2,258) provided post treatment effect on pain and 24 studies (n = 2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33). There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion.
    BMC Musculoskeletal Disorders 12/2014; 15(1):416. DOI:10.1186/1471-2474-15-416 · 1.72 Impact Factor
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