BMJ 1995;310:151-154 (21 January)

Papers

Randomised controlled trial for evaluation of fitness programme for patients with chronic low back pain

H Frost, research physiotherapist,a J A Klaber Moffett, director of physiotherapy research,a J S Moser, senior physiotherapist,a J C T Fairbank, consultant orthopaedic surgeon a

a Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD

Correspondence to: Ms Frost.

Abstract

Objective: To evaluate a progressive fitness programme for patients with chronic low back pain.
Design: Single blind randomised controlled trial. Assessments were carried out before and after treatment by an observer blinded to the study and included a battery of validated measures. All patients were followed up by postal questionnaire six months after treatment.
Setting: Physiotherapy department of orthopaedic hospital.
Subjects: 81 patients with chronic low back pain referred from orthopaedic consultants for physiotherapy. The patients were randomly allocated to a fitness programme or control group.
Intervention: Both groups were taught specific exercises to carry out at home and referred to a back-school for education in back care. Patients allocated to the fitness class attended eight exercise classes over four weeks in addition to the home programme and backschool.
Results: Significant differences between the groups were shown in the changes before and after treatment in scores on the Oswestry low back pain disability index (P<0.005), pain reports (sensory P<0.005 and affective P<0.005), self efficacy reports (P<0.005), and walking distance (P<0.005). No significant differences between the groups were found by the general health questionnaire or questionnaire on pain locus of control. A benefit of about 6 percentage points on the disability index was maintained by patients in the fitness group at six months.
Conclusion: There is a role for supervised fitness programmes in the management of moderately disabled patients with chronic low back pain. Further clinical trials, however, need to be established in other centres to confirm these findings.

Key messages

  • Key messages

  • Recent research suggests a need for a more dynamic approach with a move away from long term rest towards progressive activity and exercise

  • This study shows that a supervised fitness programme can help to reduce pain and disability and improve patients' confidence

  • Beneficial effects of treatment were maintained six months after treat- ment when compared with a control group who were advised to exercise independently

  • Simply advising patients with low back pain to exercise is not effective in reducing disability and pain


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

This article has been cited by other articles:

  • Little, P., Lewith, G., Webley, F., Evans, M., Beattie, A., Middleton, K., Barnett, J., Ballard, K., Oxford, F., Smith, P., Yardley, L., Hollinghurst, S., Sharp, D. (2008). Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ 337: a884-a884 [Abstract] [Full text]  
  • Chatzitheodorou, D., Kabitsis, C., Malliou, P., Mougios, V. (2007). A Pilot Study of the Effects of High-Intensity Aerobic Exercise Versus Passive Interventions on Pain, Disability, Psychological Strain, and Serum Cortisol Concentrations in People With Chronic Low Back Pain. ptjournal 87: 304-312 [Abstract] [Full text]  
  • Grant, J. A., Mohtadi, N. G. H., Maitland, M. E., Zernicke, R. F. (2005). Comparison of Home Versus Physical Therapy-Supervised Rehabilitation Programs After Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial. Am J Sports Med 33: 1288-1297 [Abstract] [Full text]  
  • Carr, J. L., Klaber Moffett, J. A. (2005). Review Paper: The impact of social deprivation on chronic back pain outcomes. Chronic Illness 1: 121-129 [Abstract]  
  • Hayden, J. A., van Tulder, M. W., Malmivaara, A. V., Koes, B. W. (2005). Meta-Analysis: Exercise Therapy for Nonspecific Low Back Pain. ANN INTERN MED 142: 765-775 [Abstract] [Full text]  
  • Hayden, J. A., van Tulder, M. W., Tomlinson, G. (2005). Systematic Review: Strategies for Using Exercise Therapy To Improve Outcomes in Chronic Low Back Pain. ANN INTERN MED 142: 776-785 [Abstract] [Full text]  
  • Koumantakis, G. A, Watson, P. J, Oldham, J. A (2005). Trunk Muscle Stabilization Training Plus General Exercise Versus General Exercise Only: Randomized Controlled Trial of Patients With Recurrent Low Back Pain. ptjournal 85: 209-225 [Abstract] [Full text]  
  • Engstrom, L. O., Oberg, B. (2005). Patient adherence in an individualized rehabilitation programme: A clinical follow-up. Scand J Public Health 33: 11-18 [Abstract]  
  • UK BEAM Trial Team, (2004). United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 329: 1377- [Abstract] [Full text]  
  • Vollenbroek-Hutten, M. M., Hermens, H. J, Wever, D., Gorter, M., Rinket, J., IJzerman, M. J (2004). Differences in outcome of a multidisciplinary treatment between subgroups of chronic low back pain patients defined using two multiaxial assessment instruments: the Multidimensional Pain Inventory and lumbar dynamometry. Clin Rehabil 18: 566-579 [Abstract]  
  • Gaber, T.-Z., McGlashan, K A, Love, S, Jenner, J R, Crisp, A J (2002). Bone density in chronic low back pain: a pilot study. Clin Rehabil 16: 867-870 [Abstract]  
  • Foster, L., Clapp, L., Erickson, M., Jabbari, B. (2001). Botulinum toxin A and chronic low back pain: A randomized, double-blind study. Neurology 56: 1290-1293 [Abstract] [Full text]  
  • Smith, B. H, Hopton, J. L, Chambers, W A. (1999). Chronic pain in primary care. Fam Pract 16: 475-482 [Abstract] [Full text]  
  • Moffett, J. K., Torgerson, D., Bell-Syer, S., Jackson, D., Llewlyn-Phillips, H., Farrin, A., Barber, J. (1999). Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences. BMJ 319: 279-283 [Abstract] [Full text]  
  • Samanta, A., Beardsley, J. (1999). Evidence based case report: Low back pain: which is the best way forward?. BMJ 318: 1122-1123 [Full text]  
  • Keen, S., Dowell, A. C, Hurst, K., Moffett, J. A K., Tovey, P., Williams, R. (1999). Individuals with low back pain: how do they view physical activity?. Fam Pract 16: 39-45 [Abstract] [Full text]  
  • Randlov, A., Ostergaard, M., Manniche, C., Kryger, P., Jordan, A., Heegaardand, S., Holm, B. (1998). Intensive dynamic training for females with chronic neck/shoulder pain. A randomized controlled trial. Clin Rehabil 12: 200-210 [Abstract]  
  • Fulcher, K. Y, White, P. D (1997). Randomised controlled trial of graded exercise in patients with the chronic fatigue syndrome. BMJ 314: 1647-1647 [Abstract] [Full text]  
  • Gill, P, Dowell, A C, Neal, R D, Smith, N, Heywood, P, Wilson, A E (1996). Evidence based general practice: a retrospective study of interventions in one training practice. BMJ 312: 819-821 [Abstract] [Full text]  
  • Little, P., Smith, L., Cantrell, T., Chapman, J., Langridge, J., Pickering, R. (1996). General practitioners' management of acute back pain: a survey of reported practice compared with clinical guidelines. BMJ 312: 485-488 [Abstract] [Full text]  
  • Glenister, D. (1996). Exercise and mental health: a review. The Journal of the Royal Society for the Promotion of Health 116: 7-13 [Abstract]  
  • Williams, M (1995). Fitness programme for chronic low back pain. BMJ 310: 1332b-1332 [Full text]  
  • (1995). Supervised Exercise Helps Chronic Low Back Pain. Journal Watch Dermatology 1995: 18-18 [Full text]  
  • (1995). SUPERVISED EXERCISE HELPS CHRONIC LOW BACK PAIN. JWatch General 1995: 1-1 [Full text]  
Access all current jobs at BMJ Group
Whats new online at Student BMJ
Listen to the latest BMJ Interview