Background: Exercise is recommended as an effective treatment for patients with sub-acute and chronic low back pain (LBP). Which exercise regimen is the most effective for which LBP subgroup remains unclear. Purpose: Movement control impairment (MCI) can be reliably assessed in patients with LBP. This study compared the effectiveness of a specifically tailored movement control exercise programme (MC) versus a general exercise (GE) programme with pre- and post-treatment measurement, 6- months and 1-year follow up. Methods: After baseline assessment 106 patients were randomly allocated to one of two groups (MC = 52; GE = 54) and treated in 13 physiotherapy clinics. The two main inclusion criteria were 2 out of 6 positively tested MCI signs and < 135 points on the Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ). All patients received individual physiotherapy treatments (mean n = 8 in MC; 9 in GE) and were instructed to do their exercises at home for the next year. In MC intervention the specific impaired-movement was normalised, while the GE intervention involved general strength training. Primary outcome was disability measured with Patient Specific Functional Scale (PSFS). Secondary outcomes assessed were pain on the Graded Chronic Pain Scale (GCPS) and disability with the Roland-Morris Disability Questionnaire (RMDQ). Outcome assessors and data analysts were blinded to allocation and were not involved in treatment. Statistical analysis followed the intension to treat principle. Univariate analysis of variance (ANOVA) for the primary outcome and subsequent analysis of covariance (ANCOVA) analysed the potential influence of covariates. Final analysis was performed with linear mixed models. Results: MC was not more effective than GE in patients with LBP. The time and group interaction effect for the PSFS was not significant. Pain duration, which was significantly different at baseline, had no influence on the between group effect. However, both groups improved significantly over time (p < 0.001). For secondary results pain differences (GCPS) were non-significant at all follow-ups. Conclusion(s): Both exercise regimens, are equally effective in patients with LBP and MCI. No additional benefit was found for specifically tailored MC exercises on top of the significant improvement in both groups. This unexpected improvement in both groups may be influenced by the selection of patients with a more positive prognosis and/or the common characteristics of the interventions like raising the level of activity of the patient. More research is needed to unravel this situation. Implications: For patients with LPB and signs of MCI both exercise programmes are comparable to improve function and pain.
Saner, J., Luomajoki, H., Sieben, J. M., Kool, J., Bastiaenen, C. H., & de Bie, R. A. (2015). Movement control exercise versus general exercise to reduce disability in patients with low back pain: randomized controlled multicentre study. Physiotherapy, 101, e917–e918. https://doi.org/10.1016/j.physio.2015.03.1759