Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: a pilot randomised controlled trial.

The aim of this single-blind pilot RCT was to investigate the effect of pain biology education and group exercise classes compared to pain biology education alone for individuals with chronic low back pain (CLBP). Participants with CLBP were randomised to a pain biology education and group exercise classes group (EDEX) [n = 20] or a pain biology education only group (ED) [n = 18]. The primary outcome was pain (0-100 numerical rating scale), and self-reported function assessed using the Roland Morris Disability Questionnaire, measured at pre-intervention, post-intervention and three month follow up. Secondary outcome measures were pain self-efficacy, pain related fear, physical performance testing and free-living activity monitoring. Using a linear mixed model analysis, there was a statistically significant interaction effect between time and intervention for both pain (F[2,49] = 3.975, p < 0.05) and pain self-efficacy (F[2,51] = 4.011, p < 0.05) with more favourable results for the ED group. The effects levelled off at the three month follow up point. In the short term, pain biology education alone was more effective for pain and pain self-efficacy than a combination of pain biology education and group exercise classes. This pilot study highlights the need to investigate the combined effects of different interventions.

[1]  M. Nicholas,et al.  The pain self‐efficacy questionnaire: Taking pain into account , 2007, European journal of pain.

[2]  P. Richardson,et al.  The influence of the physiotherapist-patient relationship on pain and disability , 1997 .

[3]  J. Dolce Self-efficacy and disability beliefs in behavioral treatment of pain. , 1987, Behaviour research and therapy.

[4]  S. Braver,et al.  The measurement of clinical pain intensity: a comparison of six methods , 1986, Pain.

[5]  S. Lamb,et al.  A fitness programme for patients with chronic low back pain: 2-year follow-up of a randomised controlled trial , 1998, Pain.

[6]  J B Bussmann,et al.  Techniques for measurement and assessment of mobility in rehabilitation: a theoretical approach , 1998, Clinical rehabilitation.

[7]  Uk Beam Trial Team,et al.  United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care , 2004, BMJ : British Medical Journal.

[8]  G. Waddell,et al.  Concepts of rehabilitation for the management of low back pain. , 2005, Best practice & research. Clinical rheumatology.

[9]  H. Ursin,et al.  Chapter 4 European guidelines for the management of chronic nonspecific low back pain , 2006, European Spine Journal.

[10]  G. Crombez,et al.  Confirmatory Factor Analysis of the Tampa Scale for Kinesiophobia: Invariant Two-Factor Model Across Low Back Pain Patients and Fibromyalgia Patients , 2004, The Clinical journal of pain.

[11]  C. Bombardier,et al.  WITHDRAWN: Multidisciplinary bio-psycho-social rehabilitation for chronic low-back pain. , 2007, The Cochrane database of systematic reviews.

[12]  Edgar Erdfelder,et al.  G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences , 2007, Behavior research methods.

[13]  N. Summerton,et al.  Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care. , 1999, Spine.

[14]  P. Wilson,et al.  Comparison of cognitive-behavioral group treatment and an alternative non-psychological treatment for chronic low back pain , 1992, Pain.

[15]  D. Torgerson,et al.  Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences , 1999, BMJ.

[16]  M. Jensen,et al.  Assessing Global Pain Severity by Self-Report in Clinical and Health Services Research , 2000, Spine.

[17]  M. Granat,et al.  The validation of a novel activity monitor in the measurement of posture and motion during everyday activities , 2006, British Journal of Sports Medicine.

[18]  J. Fairbank,et al.  Randomised controlled trial for evaluation of fitness programme for patients with chronic low back pain , 1995, BMJ.

[19]  M. Granat,et al.  The validity and reliability of a novel activity monitor as a measure of walking , 2006, British Journal of Sports Medicine.

[20]  G. Moseley,et al.  Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain , 2004, European journal of pain.

[21]  A. Brucker Combined Physiotherapy and Education is Efficacious for Chronic Low Back Pain , 2004 .

[22]  R. Ostelo,et al.  The Back Pain Beliefs of Health Care Providers: Are We Fear-Avoidant? , 2002, Journal of Occupational Rehabilitation.

[23]  M. Nordin,et al.  The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain. , 2000, Spine.

[24]  G. Moseley,et al.  Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain. , 2005, The Australian journal of physiotherapy.

[25]  P. Heslop,et al.  Spontaneous ambulatory activity as a quantifiable outcome measure for osteoarthritis of the knee. , 1998, British journal of rheumatology.

[26]  P. Little,et al.  Should We Give Detailed Advice and Information Booklets to Patients With Back Pain?: A Randomized Controlled Factorial Trial of a Self-Management Booklet and Doctor Advice to Take Exercise for Back Pain , 2001, Spine.

[27]  G M Lyons,et al.  Comparison of the performance of the activPAL Professional physical activity logger to a discrete accelerometer-based activity monitor. , 2007, Medical engineering & physics.

[28]  Jane L. Carr,et al.  High Fear-Avoiders of Physical Activity Benefit From an Exercise Program for Patients With Back Pain , 2004, Spine.

[29]  M. Simmonds,et al.  Psychometric Characteristics and Clinical Usefulness of Physical Performance Tests in Patients With Low Back Pain , 1998, Spine.

[30]  J. Moffett,et al.  Back to Fitness Programme , 2000 .

[31]  P. Heslop,et al.  Spontaneous ambulatory activity as a quantifiable outcome measure for rheumatoid arthritis. , 1999, Rheumatology.

[32]  A. Morris Patients' perspectives on self-management following a back rehabilitation programme. , 2004, Musculoskeletal care.

[33]  Hélène Corriveau,et al.  Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Low Back Pain , 2001 .

[34]  G. Hilde,et al.  Effect of exercise in the treatment of chronic low back pain: a systematic review, emphasising type and dose of exercise , 1998 .

[35]  B. Dobkin,et al.  Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. , 2001, Physical therapy.

[36]  M. Roland,et al.  The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. , 2000, Spine.

[37]  R. Gatchel,et al.  Exploration of Physicians’ Recommendations for Activities in Chronic Low Back Pain , 2000, Spine.

[38]  Paul W. Hodges,et al.  A Randomized Controlled Trial of Intensive Neurophysiology Education in Chronic Low Back Pain , 2004, The Clinical journal of pain.

[39]  A. Mannion,et al.  What is the value of physical therapies for back pain? , 2005, Best practice & research. Clinical rheumatology.