Exercise therapy for chronic low back pain.
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ABSTRACT:
SUBMITTER: Hayden JA
PROVIDER: S-EPMC8477273 | biostudies-literature | 2021 Sep
REPOSITORIES: biostudies-literature
Publications
Exercise therapy for chronic low back pain.
Hayden Jill A JA Ellis Jenna J Ogilvie Rachel R Malmivaara Antti A van Tulder Maurits W MW
The Cochrane database of systematic reviews 20210928
<h4>Background</h4>Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs.<h4>Objectives</h4>The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments.<h4>Search methods</h4>We searche ...[more]
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Project description:BackgroundChronic low back pain (CLBP) is one of the most common musculoskeletal problems worldwide. Even though regular exercise is recommended as the primary conservative approach in treating this condition, significant part of patients lead sedentary lifestyle. Motivation to exercise is one of the variables that effects the adherence of exercise-based treatments. This study aimed to characterize the motives for exercise, as posited by self-determination theory, in persons with CLBP, and to identify subgroups (clusters) of motivational profiles in combination with socioeconomic and clinical characteristics using k-means cluster analysis.MethodsData were collected between September 2022 and September 2023. A total of 103 adults with CLBP completed the paper-pencil Exercise Self-Regulation Questionnaire (SRQ-E) and provided self-reported measures on anthropometric and socio-economic characteristics. Inclusion criteria were age (≥ 18 years) and non-specific CLBP (lasting longer than 12 weeks). Exclusion criteria included specific lumbar spine pathology (e.g., fracture, cancer), worsening neurological symptoms, recent injection therapy (within 3 months), and current alcohol or drug misuse.ResultsThree distinct motivational clusters were identified among the 103 participants: two clusters were characterized by predominantly autonomous motivation (moderately motivated cluster: 31.1%; highly motivated cluster: 54.4%), while one cluster (controlled convinced cluster: 14.6%) showed a higher level of controlled motivation. Associations were observed between the controlled cluster and factors such as higher disability scores, longer duration of pain, greater number of completed physiotherapy sessions, and elevated BMI. Notably, the controlled motivation cluster was linked with poorer clinical outcomes.ConclusionsThis study provides insights into the exercise motivation of patients with CLBP, revealing that while most patients were primarily autonomously motivated, a notable subgroup exhibited lower, controlled motivation. The presence of controlled motivation was associated with worse functioning, longer pain duration, and increased utilization of physiotherapy services. Although these findings suggest a link between motivational profiles and clinical outcomes, the cross-sectional design limits causal inferences. Further research is needed to explore these relationships longitudinally.Trial registrationClinicalTrials.Gov Identifier: NCT05512338 (22.8.2022, NCT05512338).
| S-EPMC11883927 | biostudies-literature
Project description: Not available
| S-EPMC8761501 | biostudies-literature
Project description:Background:Low back pain (LBP) is a common disabling condition in older adults which often limits physical function and diminishes quality of life. Two clinical trials in older adults have shown spinal manipulative therapy (SMT) results in similar or small improvements relative to medical care; however, the effectiveness of adding SMT or rehabilitative exercise to home exercise is unclear. Methods:We conducted a randomized clinical trial assessing the comparative effectiveness of adding SMT or supervised rehabilitative exercise to home exercise in adults 65 or older with sub-acute or chronic LBP. Treatments were provided over 12-weeks and self-report outcomes were collected at 4, 12, 26, and 52 weeks. The primary outcome was pain severity. Secondary outcomes included back disability, health status, medication use, satisfaction with care, and global improvement. Linear mixed models were used to analyze outcomes. The primary analysis included longitudinal outcomes in the short (week 4-12) and long-term (week 4-52). An omnibus test assessing differences across all groups over the year was used to control for multiplicity. Secondary analyses included outcomes at each time point and responder analyses. This study was funded by the US Department of Health and Human Services, Health Resources and Services Administration. Results:241 participants were randomized and 230 (95%) provided complete primary outcome data. The primary analysis showed group differences in pain over the one-year were small and not statistically significant. Pain severity was reduced by 30 to 40% after treatment in all 3 groups with the largest difference (eight percentage points) favoring SMT and home exercise over home exercise alone. Group differences at other time points ranged from 0 to 6 percentage points with no consistent pattern favoring one treatment. One-year post-treatment pain reductions diminished in all three groups. Secondary self-report outcomes followed a similar pattern with no important group differences, except satisfaction with care, where the two combination groups were consistently superior to home exercise alone. Conclusions:Adding spinal manipulation or supervised rehabilitative exercise to home exercise alone does not appear to improve pain or disability in the short- or long-term for older adults with chronic low back pain, but did enhance satisfaction with care. Trial registration:NCT00269321.
| S-EPMC6518769 | biostudies-literature
Project description:ObjectiveTo review the effects of core stability exercise or general exercise for patients with chronic low back pain (LBP).Summary of background dataExercise therapy appears to be effective at decreasing pain and improving function for patients with chronic LBP in practice guidelines. Core stability exercise is becoming increasingly popular for LBP. However, it is currently unknown whether core stability exercise produces more beneficial effects than general exercise in patients with chronic LBP.MethodsPublished articles from 1970 to October 2011 were identified using electronic searches. For this meta-analysis, two reviewers independently selected relevant randomized controlled trials (RCTs) investigating core stability exercise versus general exercise for the treatment of patients with chronic LBP. Data were extracted independently by the same two individuals who selected the studies.ResultsFrom the 28 potentially relevant trials, a total of 5 trials involving 414 participants were included in the current analysis. The pooling revealed that core stability exercise was better than general exercise for reducing pain [mean difference (-1.29); 95% confidence interval (-2.47, -0.11); P = 0.003] and disability [mean difference (-7.14); 95% confidence interval (-11.64, -2.65); P = 0.002] at the time of the short-term follow-up. However, no significant differences were observed between core stability exercise and general exercise in reducing pain at 6 months [mean difference (-0.50); 95% confidence interval (-1.36, 0.36); P = 0.26] and 12 months [mean difference (-0.32); 95% confidence interval (-0.87, 0.23); P = 0.25].ConclusionsCompared to general exercise, core stability exercise is more effective in decreasing pain and may improve physical function in patients with chronic LBP in the short term. However, no significant long-term differences in pain severity were observed between patients who engaged in core stability exercise versus those who engaged in general exercise.Systematic review registrationhttp://www.crd.york.ac.uk/PROSPERO PROSPERO registration number: CRD42011001717.
| S-EPMC3524111 | biostudies-literature
Project description:ObjectiveThe aim of this study was to assess the feasibility and potential effectiveness of an 8-week virtual EMG biofeedback intervention for patients with CLBP.MethodsPatients with CLBP completed validated baseline and post-intervention assessments of pain intensity and interference (Brief Pain Inventory), back pain-related disability (Oswestry Disability Index), anxiety and depression (Hospital Anxiety and Depression Scale). Participants underwent a series of Quantitative Sensory Testing (QST) procedures assessing responses to mechanical stimuli during two separate visits (baseline and post-intervention). In addition, we assessed, using surface EMG, the muscle tension in the trapezius, latissimus, and low back muscles at each session. Patients were randomized into the EMG biofeedback intervention or usual care group. Factorial analysis of variance including the interaction between treatment group and time was used to analyze the changes in pain intensity (primary outcome), pain interference, disability (secondary outcomes), anxiety, and depression (secondary outcomes).ResultsCompared to the treatment as usual comparison group, patients in the EMG biofeedback group reported lower pain intensity after completing the intervention (mean group difference 0.9, 95% CI -1.07, -0.32; p≤0.01). Compared to baseline, participants in the EMG biofeedback group demonstrated statistically significant reductions in pain interference (mean difference 1.3, 95% CI 0.42, 2.1; p≤0.01), disability (mean difference 4.32, 95% CI 1.2, 7.3; p≤0.01), and significant increases in low back pain thresholds (mean difference 0.5, 95% CI -0.87, -0.05; p≤0.01), assessed by QST. However, no significant group by time effects were observed for secondary outcomes: pain interference, disability, and low back pain thresholds. In addition, significant changes were observed in muscle tension for the trapezius, latissimus, and low back muscles in the EMG biofeedback group (p<0.001).ConclusionsVirtual EMG biofeedback shows promise as a potential therapy for reducing pain and disability in individuals with chronic nonspecific low back pain.
| S-EPMC9909059 | biostudies-literature
Project description:BackgroundTrials on sling exercise (SE), commonly performed to manage chronic low back pain (LBP), yield conflicting results. This study aimed to review the effects of SE on chronic LBP.MethodsThe randomized controlled trials comparing SE with other treatments or no treatment, published up to August 2013, were identified by electronic searches. Primary outcomes were pain, function, and return to work. The weighted mean difference (WMD) and 95% confidence interval (CI) were calculated, using a random-effects model.ResultsRisk of bias was rated as high in 9 included trials, where some important quality components such as blinding were absent and sample sizes were generally small. We found no clinically relevant differences in pain or function between SE and other forms of exercise, traditional Chinese medical therapy, or in addition to acupuncture. Based on two trials, SE was more effective than thermomagnetic therapy at reducing pain (short-term: WMD -13.90, 95% CI -22.19 to -5.62; long-term: WMD -26.20, 95% CI -31.32 to -21.08) and improving function (short-term: WMD -10.54, 95% CI -14.32 to -6.75; long-term: WMD -25.75, 95% CI -30.79 to -20.71). In one trial we found statistically significant differences between SE and physical agents combined with drug therapy (meloxicam combined with eperisone hydrochloride) but of borderline clinical relevance for pain (short-term: WMD -15.00, 95% CI -19.64 to -10.36) and function (short-term: WMD -10.00; 95% CI -13.70 to -6.30). There was substantial heterogeneity among the two trials comparing SE and thermomagnetic therapy; both these trials and the trial comparing SE with physical agents combined with drug therapy had serious methodological limitations.InterpretationBased on limited evidence from 2 trials, SE was more effective for LBP than thermomagnetic therapy. Clinically relevant differences in effects between SE and other forms of exercise, physical agents combined with drug therapy, traditional Chinese medical therapy, or in addition to acupuncture could not be found. More high-quality randomized trials on the topic are warranted.
| S-EPMC4053356 | biostudies-literature
Project description:BackgroundAmong the most effective therapeutic interventions in non-specific chronic low back pain, clinical practice guidelines highlight exercise therapy and patient education. However, the variability in the type of exercise and its dosage means that there is no clear evidence regarding the most optimal form of therapeutic exercise.AimThe main objective of this study was to ascertain the effects produced by two different exercise interventions (supervised exercise therapy and laser-guided exercise therapy) and pain neuroscience education on postural control measured by the displacement center of pressure (CoP) and energy spectral density (ESD) in subjects with non-specific chronic low back pain.DesignThis is a single-blinded randomized clinical comparative controlled trial.SettingThe study was carried out in different private physiotherapy care centers.PopulationWe enrolled 60 subjects with non-specific chronic low back pain of at least 3-month duration, aged 18-45 years.MethodsBoth groups performed a total of 16 therapeutic exercise sessions and 8 pain neuroscience education sessions, with the laser-guided exercise therapy group performing laser-guided exercises. The main outcome measures evaluated were ESD and displacement of CoP measured at 3 different times (baseline, post-treatment, and 3 month follow-up).ResultsThe most important differences for ESD and displacement of CoP variables were obtained for eyes open, unstable surface anteroposterior axis (F(2,92)=7.36, P=0.001, d=0.71) and eyes closed, stable surface mediolateral axis (F(2,92)=3.24, P<0.001, d=0.76). Further, time × group interactions showed significant statistical differences in both cases as well as significant differences between baseline and 3 month's follow-up.ConclusionsBoth exercise modalities (supervised exercise therapy and laser-guided exercise therapy) showed changes in variables related to postural control (displacement of CoP and ESD). However, the laser-guided exercise therapy program showed greater improvements in ESD.Clinical rehabilitation impactAnalysis of a new approach for the quantification of data obtained from postural control assessment relying on widely used devices (accelerometers and pressure platforms).
| S-EPMC10170322 | biostudies-literature
Project description:BackgroundInitiating and maintaining physical activity is particularly difficult for at-risk groups such as those with chronic low back pain (LBP).ObjectiveThis study aimed to assess whether there is a relationship between perceived social support (e.g., emotional and physical support) in individuals recently discharged from treatment for chronic LBP and the number of exercise sessions and total amount of exercise they perform over a 6-month period. This study also aimed to investigate a possible mediation effect of exercise self-efficacy on the relationship between perceived social support and exercise adherence (number of exercise sessions and total amount of exercise).MethodsThis prognostic study employed a secondary analysis of data collected for The Buddy Study; Data was collected through online weekly diaries over a 6-month period. Poisson regression analyses were used to quantify the relationship between social support at baseline and total number of exercise sessions, and total amount of exercise performed (frequency and duration) in the 6-month follow-up period. Where a relationship was observed, the Stata SEM command was used for the mediation analysis.ResultsA positive relationship was found between participants' perceived levels of social support at baseline and the total number of exercise sessions they performed (IRR = 1.56, 95%CI: 1.18 to 2.06) and the total amount of exercise they performed (IRR = 1.57, 95%CI: 1.05 to 2.35) during the 6-month follow-up period. No mediating relationship was found between exercise self-efficacy at 3-months and the total number of exercise sessions performed (β 3.96, 95% CI: -4.91 to 12.84), or the total amount of exercise performed (β 243.96, 95% CI: -258.08 to 746.01).ConclusionSocial support is potentially an important aspect of exercise adherence, following discharge from treatment, for those with chronic LBP. People's self-efficacy to exercise does not appear to mediate this relationship. Harnessing social support following physiotherapy treatment may increase exercise adherence and may therefore improve long term outcomes for those with chronic LBP.
| S-EPMC11612981 | biostudies-literature
Project description:Background: Coronavirus disease 2019 prompted the rapid adoption of telehealth to provide physical therapy. Patients' perceptions about telehealth physical therapy are mostly unknown. This study describes perceptions of telehealth physical therapy among patients with chronic low back pain (LBP). Methods: This study surveyed participants in an ongoing multisite clinical trial of nonpharmacological LBP treatments. Participants were asked about their willingness to use telehealth for physical therapy and with other providers and completed the PROMIS-29. Results: Surveys were received from 102 participants (mean age = 48.5 [standard deviation; SD = 11.6]). Thirty-six (35.3%) expressed willingness to receive telehealth physical therapy, 22 were neutral (21.6%), and 44 were unwilling (43.1%). The percentage expressing willingness for telehealth physical therapy was lower than it was for family medicine (p < 0.001) or mental health (p < 0.001). Older (p = 0.049) and Black participants (p = 0.01) more likely expressed willingness to use telehealth for physical therapy. Conclusion: Education and familiarity may help patients view telehealth physical therapy more favorably. Clinical Trial Registration (clinicaltrials.gov NCT03859713).
| S-EPMC8670598 | biostudies-literature
Project description:BackgroundA biopsychosocial rehabilitation is recommended for chronic nonspecific low back pain (CNLBP); however, its effectiveness compared to the traditional supervised exercise therapy of CNLBP treatment is still unclear.MethodsThis was a parallel-group randomized controlled clinical trial. The sample consisted of 180 participants of both sexes, aged ≥18 years, with CNLBP for ≥3 months. Using web randomization and concealed allocation, they were assigned to three groups; graded activity receiving cognitive-behavioral therapy, group-based combined exercise therapy and education (GA; n = 59), supervised group-based combined exercise therapy and education (SET; n = 63), and a control group receiving usual care (n = 58). Interventions were administered for 4 weeks (8 sessions). The primary outcome was pain intensity. Outcome measures were collected baseline, after interventions (4 weeks), and during two follow-up periods (3 and 6 months).ResultsAfter the intervention, GA had a significant large effect on pain reduction compared to the control group (MD of 22.64 points; 95% CI = 16.10 to 29.19; p < 0.0001; Cohen's d = 1.70), as well as SET compared with the control group (MD of 21.08 points; 95% CI = 14.64 to 27.52; p < 0.0001; Cohen's d = 1.39), without significant difference between two intervention groups. At 3 and 6 months of follow-up, GA had a statistically significantly better effect in reducing pain, disability and fear-avoidance beliefs, and improving spinal extensor endurance, range of extension and quality of life compared to SET and the control group. A statistically significantly better effect of SET compared with the control group was found in reducing pain, disability, fear-avoidance beliefs, and improving the physical component of quality of life. Harms were not reported.ConclusionThis study suggests that graded activity and group-based supervised exercise therapy have beneficial effects over the control group in the treatment of CNLBP. The graded activity was more beneficial than supervised group-based exercise therapy only during the follow-up.Trial registrationClinicaltrials.gov (NCT04023162; registration date: 17/07/2019).
| S-EPMC9641911 | biostudies-literature