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

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