Intensive group training protocol versus guideline physiotherapy for patients with chronic low back pain: a randomised controlled trial

“Intensive group training protocol versus guideline physiotherapy for patients with chronic low back pain: a randomised controlled trial”
Nicole van der Roer , Maurits van Tulder , Johanna Barendse, Dirk Knol , Willem van Mechelen , Henrica de Vet

A study that compares the effects of an intensive group training protocol aimed at returning to normal daily activities and guideline physiotherapy for primary care patients with non-specific chronic low back pain.

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Article – Intensive Group Training Principles – Pitfalls

Abstract

Intensive group training using principles of
graded activity has been proven to be effective in occupational care for workers with chronic low back pain.
Objective of the study was to compare the effects of an
intensive group training protocol aimed at returning to
normal daily activities and guideline physiotherapy for
primary care patients with non-specific chronic low back
pain. The study was designed as pragmatic randomised
controlled trial with a setup of 105 primary care physiotherapists in 49 practices and 114 patients with non-specific
low back pain of more than 12 weeks duration participated
in the study. In the intensive group training protocol
exercise therapy, back school and operant-conditioning
behavioural principles are combined. Patients were treated
during 10 individual sessions along 20 group sessions.
Usual care consisted of physiotherapy according to the
Dutch guidelines for Low Back Pain. Main outcome
measures were functional disability (Roland Morris disability questionnaire), pain intensity, perceived recovery
and sick leave because of low back pain assessed at
baseline and after 6, 13, 26 and 52 weeks. Both an intention-to-treat analysis and a per-protocol analysis were
performed. Multilevel analysis did not show significant
differences between both treatment groups on any outcome
measures during the complete follow-up period, with one
exception. After 26 weeks the protocol group showed more
reduction in pain intensity than the guideline group, but
this difference was absent after 52 weeks. We finally
conclude that an intensive group training protocol was not
more effective than usual physiotherapy for chronic low
back pain.

Keywords: Low back pain
Physiotherapy

Randomized controlled trial
Graded activity

Group training