Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial

Brønfort, Gert; Maiers, Michele; Evans, Roni; Schulz, Craig; Bracha, Yiscah; Svendsen, Kenneth H.; Grimm, Richard H.; Owens, Edward F.; Garvey, Timothy A.; Transfeldt, Ensor E.

doi:10.1016/j.spinee.2011.01.036

Cited by 128 publications

(105 citation statements)

References 41 publications

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“…This qualitative study is part of a prospective, mixedmethods randomized clinical trial with an embedded design (Clinical trials registry number: NCT00269347) [21]. The primary aim of this RCT was to compare the effectiveness of high-dose supervised exercise, chiropractic spinal manipulation and home exercise for chronic, non-specific LBP.…”

Section: Methodsmentioning

confidence: 99%

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How do low back pain patients conceptualize their expectations regarding treatment? Content analysis of interviews

et al. 2013

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Purpose The purpose of this study was to gain insight into how low back pain (LBP) patients conceptualize the construct of expectations regarding treatment. Methods This study was nested within a mixed-method randomized clinical trial comparing three primary care interventions for LBP. A total of 77 participants with LBP lasting longer than 6 weeks were included; semi-structured interviews were conducted querying patients about their expectations for treatment. Also factors influencing their expectations were explored. Interviews were administered following enrollment into the study, but prior to study treatment. Two researchers independently conducted a content analysis using NVIVO 9 software. Results LBP patients' expectations could be categorized in two main domains: outcome and process expectations, each with subdomains. Patients expressed expectations in all subdomains both as values (what they hoped) and probabilities (what they thought was likely). In multiple subdomains, there were differences in the nature (positive vs. negative) and frequency of value and probability expectations. Participants reported that multiple factors influenced their expectations of which past experience with treatment appeared to be of major influence on probability expectations. Conclusion and recommendations This study showed that LBP patients' expectations for treatment are multifaceted. Current measurement instruments do not cover all domains and subdomains of expectations. Therefore, we recommend the development of new or improved measures that make a distinction between value and probability expectations and assess process and/or outcome expectations covering multiple subdomains. Some of the influencing factors found in this study may be useful targets for altering patients' treatment expectations and improving health outcomes.

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Section: Methodsmentioning

confidence: 99%

“…More information related to the design and results of the parent trial are reported elsewhere [21]. We invited consecutive participants to take part in the qualitative interview, which took place immediately after they were randomized to a treatment group but prior to receiving their first treatment.…”

Section: Participantsmentioning

confidence: 99%

How do low back pain patients conceptualize their expectations regarding treatment? Content analysis of interviews

et al. 2013

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“…Significant improvement was reported in their pain levels and disability [9]. In a study conducted by Bronfort et al in 2011 [13] on 301 patients diagnosed with chronic back pain, it was found that supervised exercise improved trunk strength and endurance and produced high levels of patient satisfaction [13]. A systematic review using 43 randomized controlled trials on 72 exercise treatments and 31 comparison groups for chronic pain was done by Hayden et al in 2005 [14].…”

Section: Discussionmentioning

confidence: 99%

Referring doctors' perspectives about Physiotherapy management for chronic musculoskeletal pain

Rajan¹,

Bellare²

2013

IJTRR

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Background: Patients diagnosed with chronic disabling musculoskeletal pain have better health outcomes and higher levels of satisfaction with Physiotherapy management. A pilot study conducted by the authors found that doctor's referral to Physiotherapy treatment could have affected the satisfaction of the patients towards Physiotherapy management. Objectives:The aim of the current study was to look into the perspectives of referring doctors (physicians and surgeons) towards Physiotherapy as reported by the patients. Secondarily, it was of interest to see how the treatment strategies by the Physiotherapist affect patient satisfaction. Methods: The study was conducted at the orthopedic pain center in the Physiotherapy department at a tertiary care hospital in Mumbai, India. Personal interviews were conducted with 193 patients using a valid questionnaire. Results: The average age of the subjects was 47.5 years. Average duration of pain was close to 8 years, with low back pain being the most common location of pain. Majority of the patients were not referred for any particular Physiotherapy treatment (37.32%). Almost an equal percentage of subjects (33.16%) were referred for both exercise and electrotherapy treatments to the Physiotherapy department. Most of the times (around 68%), there was agreement in the treatment modes suggested by the referring doctor and the attending physiotherapist. However, in about 32% of the patients referred, there seemed to be a mismatch. Conclusion:The referring doctors (physicians/surgeons) gave considerable freedom to the physiotherapists regarding the treatment of chronic musculoskeletal pain. Some of them seemed to recommend electrotherapy as a treatment mode, due to which, there was dissatisfaction amongst patients about the treatment methodologies recommended by the physiotherapist.

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“…Bronfort et al 30) showed that supervised exercise was significantly better than interventions such as chiropractic manipulation and exercise at home in terms of satisfaction with treatment and trunk muscle endurance and strength of CLBP patients, with consistent short-term (12 weeks) and long-term (52 weeks) differences between groups in patient-rated pain, disability, improvement, general health status, and medication use. However, these differences were relatively small and not statistically significant for individual outcomes.…”

Section: Discussionmentioning

confidence: 99%

Physical Fitness of Patients with Nonspecific Low Back Pain Who Performed a Progressive Four-week Fitness Exercise Program

et al. 2012

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Abstract.[Purpose] The purpose of this study was to determine the physical fitness performance and health-related quality of life of patients with nonspecific low back pain (LBP) after a 4-week supervised fitness exercise intervention in addition to routine physical therapy.[Subjects] Twenty-four patients with nonspecific LBP participated in this study.[Methods] All participants completed either an additional supervised fitness exercise along with conventional physiotherapy twice a week for 4 weeks, or conventional physiotherapy only. Physical fitness, visual analogue scale of pain, the modified Roland-Morris Disability scale, and SF-36 assessments were made before and after the intervention.[Results] Significant improvements were found in physical fitness, including trunk flexors/extensors endurance, lower extensor strength, reaction time of the upper extremity, and the body pain domain of SF-36 after fitness exercise compared to the conventional physiotherapy alone. Decreases in pain intensity were found after treatment in both groups.[Conclusions] A 4-week supervised fitness exercise program was effective at reducing pain intensity and alleviating disability. It also improved trunk muscle endurance, lower extensor strength, and the body pain domain in health related quality of life of patients with nonspecific LBP.

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Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial

Cited by 128 publications

References 41 publications

How do low back pain patients conceptualize their expectations regarding treatment? Content analysis of interviews

How do low back pain patients conceptualize their expectations regarding treatment? Content analysis of interviews

Referring doctors' perspectives about Physiotherapy management for chronic musculoskeletal pain

Physical Fitness of Patients with Nonspecific Low Back Pain Who Performed a Progressive Four-week Fitness Exercise Program

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