Ferreira ML, Ferreira PH, Latimer J, et al. Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: a randomized trial

Pontifícia Universidade Católica de Minas Gerais, Cidade de Minas, Minas Gerais, Brazil
Pain (Impact Factor: 5.21). 10/2007; 131(1-2):31-7. DOI: 10.1016/j.pain.2006.12.008
Source: PubMed


Practice guidelines recommend various types of exercise and manipulative therapy for chronic back pain but there have been few head-to-head comparisons of these interventions. We conducted a randomized controlled trial to compare effects of general exercise, motor control exercise and manipulative therapy on function and perceived effect of intervention in patients with chronic back pain. Two hundred and forty adults with non-specific low back pain 3months were allocated to groups that received 8weeks of general exercise, motor control exercise or spinal manipulative therapy. General exercise included strengthening, stretching and aerobic exercises. Motor control exercise involved retraining specific trunk muscles using ultrasound feedback. Spinal manipulative therapy included joint mobilization and manipulation. Primary outcomes were patient-specific function (PSFS, 3-30) and global perceived effect (GPE, -5 to 5) at 8weeks. These outcomes were also measured at 6 and 12months. Follow-up was 93% at 8weeks and 88% at 6 and 12months. The motor control exercise group had slightly better outcomes than the general exercise group at 8weeks (between-group difference: PSFS 2.9, 95% CI: 0.9-4.8; GPE 1.7, 95% CI: 0.9-2.4), as did the spinal manipulative therapy group (PSFS 2.3, 95% CI: 0.4-4.2; GPE 1.2, 95% CI: 0.4-2.0). The groups had similar outcomes at 6 and 12months. Motor control exercise and spinal manipulative therapy produce slightly better short-term function and perceptions of effect than general exercise, but not better medium or long-term effects, in patients with chronic non-specific back pain.

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Available from: Chris G Maher
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    • "Therapeutically, in recent years increased activity in the field of education has culminated in the increased utilisation of, and evidence for, pain neuroscience education (Louw et al 2011, Louw et al 2014, Moseley et al 2004, Moseley 2002). In line with current best-evidence treatments utilising movement, such as aerobic exercise, are being proposed to treat patients with CLBP (Ferreira et al 2007, Mistiaen et al 2012, Nijs et al 2012). It is proposed that these treatments help patients with pain by enhancing various endogenous mechanisms (Bialosky et al 2009a, Bialosky et al 2009b, Nijs et al 2012). "
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    ABSTRACT: Can a brief tactile intervention associated with brain remapping improve pain and spinal movement in patients with chronic low back pain? A convenience sample of patients with chronic low back pain completed various pre-intervention measurements including low back pain (Numeric Pain Rating Scale), fear-avoidance (Fear Avoidance Beliefs Questionnaire), disability (Oswestry Disability Index) and spinal flexion (fingertip-to-floor). A 5-minute localization of tactile stimuli treatment was administered to the low back, followed by immediate post-intervention measurement of pain and spinal flexion. Sixteen patients (female = 12; mean age 48.2 years) with chronic low back pain (median duration 10 years) presented with a mean low back pain of 5.56 out of 10, moderate disability (mean Oswestry Disability Index 34.38%) and high fear-avoidance associated with physical activity (average 17.25). Immediately following treatment, the group’s mean pain rating for low back pain decreased by 1.91, while forward flexion improved by 4.82 cm. The results from the case series indicate that following a brief tactile discrimination intervention, patients with chronic low back pain exceeded minimal detectible change for forward flexion. Being able to improve movement, without using physical movement, may provide an added benefit for patients with chronic low back pain afraid to move.
    Full-text · Article · Jul 2015
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    • "Overall studies: n ¼ 3 (Ferreira et al., 2007; Van Der Roer et al., 2008; Dufour et al., 2010) "
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    ABSTRACT: Osteoarthritis (OA) and chronic low back pain (CLBP) are two of the most common and costly musculoskeletal conditions globally. Healthcare service demands mean that multiple condition group-based interventions are of increasing clinical interest, but no reviews have evaluated the effectiveness of group-based physiotherapy-led self-management interventions (GPSMI) for both conditions.Objectives This rapid review aimed to evaluate the effectiveness of GPSMI for OA and CLBP.DesignRapid reviews are an increasingly valid means of expediting knowledge dissemination and are particularly useful for addressing focused research questions.Method The electronic databases MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Register of Controlled Trials were searched. Structured group-based interventions that aimed to promote self-management delivered by health-care professionals (including at least one physiotherapist) involving adults' with OA and/or CLBP were included. The screening and selection of studies, data extraction and risk of bias assessment were conducted independently by two reviewers.Results22 Studies were found (10 OA, 12 CLBP). No significant difference was found between the effectiveness of GPSMI and individual physiotherapy or usual medical management for any outcome.ConclusionsGPSMI is as clinically effective as individual physiotherapy or usual medical management, but the best methods of measuring clinical effectiveness warrant further investigation. Further research is also needed to determine the cost-effectiveness of GPSMI and its implications.
    Full-text · Conference Paper · Nov 2014
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    • "In total, 22 eligible studies (detailed in 25 papers) were found that reported on a group-based physiotherapy-delivered self-management intervention (Fig. 1). Ten of the studies concerned people with OA (Hopman-Rock and Westhoff, 2000; Correa Dias et al., 2003; Hughes et al., 2004, 2006; Tak et al., 2005; Hurley et al., 2007; Jessep et al., 2009; Bearne et al., 2011; Coleman et al., 2012; Elboim-Gabyzon et al., 2012; Hurley et al., 2012; Palmer et al., 2013) with the remaining 12 concerning people with CLBP (Haldorsen et al., 1998; Sherman et al., 2005; Kaapa et al., 2006; Ferreira et al., 2007; Johnson et al., 2007; Tavafian et al., 2007, 2008; Van Der Roer et al., 2008a; Albaladejo et al., 2010; Cecchi et al., 2010; Dufour et al., 2010; Cuesta-Vargas et al., 2011; Hunter et al., 2012). In general, studies were at a moderate to low risk of bias. "

    Full-text · Conference Paper · Nov 2014
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