INTENSIVE GROUP TRAINING VERSUS COGNITIVE INTERVENTION IN SUB-ACUTE LOW BACK PAIN: SHORT-TERM RESULTS OF A SINGLE-BLIND RANDOMIZED CONTROLLED TRIAL
Kjersti Storheim , Jens Ivar Brox A2, Inger Holm A2, Anne Kathrine Koller A2, Kari Bø A1
A1 Norwegian University of Sport and Physical Education, Oslo, Norway
A2 The National Hospital, Orthopedic Department, Oslo, Norway
A3 The Norwegian University of Sport and Physical education, PB 4014 Ullevål Stadion, NO-0806 Oslo, Norway. E-mail: Kjersti.Storheim@nih.no
Objective: To evaluate the short-term effect of physical exercise and a cognitive intervention in low back pain. Design: Randomized controlled trial. Subjects: Ninety-three patients sick-listed for 8-12 weeks for sub-acute low back pain were randomized to an exercise regime (n = 30), a cognitive intervention (n = 34) or a control group (n = 29). Methods: Primary outcome measures were pain, disability, sick-listing and satisfaction with care. Secondary outcome measures were self-efficacy for pain and for function, fear-avoidance beliefs, emotional distress, generic health status and life satisfaction. Results: Eighteen percent of subjects dropped out. Drop-out was most frequent in the exercise group. At 18 weeks after inclusion fear-avoidance beliefs were reduced in both intervention groups. The cognitive group demonstrated significant improvement in disability, self-efficacy for pain, emotional distress, general health and life satisfaction. Patients in the exercise group were significantly more satisfied with the treatment, and patients following the exercise protocol reduced pain significantly. No effect on sick-listing was seen. Conclusion: Cognitive intervention improved disability and may be feasible for most patients sick-listed in the sub-acute phase. Physical exercise reduced patients' symptoms, but requires high motivation by patients. Despite positive effects in intervention groups on variables considered as negative prognostic factors for long-term disability and sickness absence, interventions had no effect on sick-listing.
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