Graded exercise for recurrent low-back pain: a randomized, controlled trial with 6-, 12-, and 36-month follow-ups

Abstract

Study design: The study was a randomized controlled trial. Treatment was for 8 weeks, with follow-up posttreatment and at 6-, 12-, and 36- months.

Objective: The purpose was to evaluate the effect of a graded exercise intervention emphasizing stabilizing exercises in patients with nonspecific, recurrent low back pain (LBP).

Summary of background data: Exercise therapy is recommended and widely used as treatment for LBP. Although stabilizing exercises are reportedly effective in the management of certain subgroups of LBP, such intervention protocols have not yet been evaluated in relation to a more general exercise regimen in patients with recurrent LBP, all at work.

Methods: Seventy-one patients recruited consecutively (36 men, 35 women) with recurrent nonspecific LBP seeking care at an outpatient physiotherapy clinic were randomized into 2 treatment groups; graded exercise intervention or daily walks. The primary outcome was perceived disability and pain at 12-month follow-up. Secondary outcomes included physical health, fear-avoidance, and self-efficacy beliefs.

Results: Of the participants, 83% provided data at the 12-month follow-up and 79% at 36 months. At 12 months, between-group comparison showed a reduction in perceived disability in favor of the exercise group, whereas such an effect for pain emerged only immediately postintervention. Ratings of physical health and self-efficacy beliefs also improved in the exercise group over the long term, though no changes were observed for fear-avoidance beliefs.

Conclusion: A graded exercise intervention, emphasizing stabilizing exercises, for patients with recurrent LBP still at work seems more effective in improving disability and health parameters than daily walks do. However, no such positive results emerged for improvement regarding pain over a longer term, or for fear-avoidance beliefs.