Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes
Exercise and spinal manipulative therapy are commonly used for the treatment of chronic low back pain (CLBP) in Australia. Reduction in pain intensity is a common outcome; however, it is only one measure of intervention efficacy in clinical practice. Therefore, we evaluated the effectiveness of two...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/6/1726 |
| _version_ | 1797566229047672832 |
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| author | Scott D. Tagliaferri Clint T. Miller Jon J. Ford Andrew J. Hahne Luana C. Main Timo Rantalainen David A. Connell Katherine J. Simson Patrick J. Owen Daniel L. Belavy |
| author_facet | Scott D. Tagliaferri Clint T. Miller Jon J. Ford Andrew J. Hahne Luana C. Main Timo Rantalainen David A. Connell Katherine J. Simson Patrick J. Owen Daniel L. Belavy |
| author_sort | Scott D. Tagliaferri |
| collection | DOAJ |
| description | Exercise and spinal manipulative therapy are commonly used for the treatment of chronic low back pain (CLBP) in Australia. Reduction in pain intensity is a common outcome; however, it is only one measure of intervention efficacy in clinical practice. Therefore, we evaluated the effectiveness of two common clinical interventions on physical and self-report measures in CLBP. Participants were randomized to a 6-month intervention of general strength and conditioning (GSC; <i>n</i> = 20; up to 52 sessions) or motor control exercise plus manual therapy (MCMT; <i>n</i> = 20; up to 12 sessions). Pain intensity was measured at baseline and fortnightly throughout the intervention. Trunk extension and flexion endurance, leg muscle strength and endurance, paraspinal muscle volume, cardio-respiratory fitness and self-report measures of kinesiophobia, disability and quality of life were assessed at baseline and 3- and 6-month follow-up. Pain intensity differed favoring MCMT between-groups at week 14 and 16 of treatment (both, <i>p</i> = 0.003), but not at 6-month follow-up. Both GSC (mean change (95%CI): −10.7 (−18.7, −2.8) mm; <i>p</i> = 0.008) and MCMT (−19.2 (−28.1, −10.3) mm; <i>p</i> < 0.001) had within-group reductions in pain intensity at six months, but did not achieve clinically meaningful thresholds (20mm) within- or between-group. At 6-month follow-up, GSC increased trunk extension (mean difference (95% CI): 81.8 (34.8, 128.8) s; <i>p</i> = 0.004) and flexion endurance (51.5 (20.5, 82.6) s; <i>p</i> = 0.004), as well as leg muscle strength (24.7 (3.4, 46.0) kg; <i>p</i> = 0.001) and endurance (9.1 (1.7, 16.4) reps; <i>p</i> = 0.015) compared to MCMT. GSC reduced disability (−5.7 (−11.2, −0.2) pts; <i>p</i> = 0.041) and kinesiophobia (−6.6 (−9.9, −3.2) pts; <i>p</i> < 0.001) compared to MCMT at 6-month follow-up. Multifidus volume increased within-group for GSC (<i>p</i> = 0.003), but not MCMT or between-groups. No other between-group changes were observed at six months. Overall, GSC improved trunk endurance, leg muscle strength and endurance, self-report disability and kinesiophobia compared to MCMT at six months. These results show that GSC may provide a more diverse range of treatment effects compared to MCMT. |
| first_indexed | 2024-03-10T19:23:45Z |
| format | Article |
| id | doaj.art-636eff9608104b47a5e3526f6974f847 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T19:23:45Z |
| publishDate | 2020-06-01 |
| publisher | MDPI AG |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-636eff9608104b47a5e3526f6974f8472023-11-20T02:44:26ZengMDPI AGJournal of Clinical Medicine2077-03832020-06-0196172610.3390/jcm9061726Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report OutcomesScott D. Tagliaferri0Clint T. Miller1Jon J. Ford2Andrew J. Hahne3Luana C. Main4Timo Rantalainen5David A. Connell6Katherine J. Simson7Patrick J. Owen8Daniel L. Belavy9Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, AustraliaInstitute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, AustraliaAdvance HealthCare, 157 Scoresby Rd, Boronia, VIC 3155, AustraliaLow Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, VIC 3083, AustraliaInstitute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, AustraliaInstitute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, AustraliaImaging@Olympic Park, AAMI Park, 60 Olympic Boulevard, Melbourne, VIC 3004, AustraliaSchool of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, AustraliaInstitute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, AustraliaInstitute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, AustraliaExercise and spinal manipulative therapy are commonly used for the treatment of chronic low back pain (CLBP) in Australia. Reduction in pain intensity is a common outcome; however, it is only one measure of intervention efficacy in clinical practice. Therefore, we evaluated the effectiveness of two common clinical interventions on physical and self-report measures in CLBP. Participants were randomized to a 6-month intervention of general strength and conditioning (GSC; <i>n</i> = 20; up to 52 sessions) or motor control exercise plus manual therapy (MCMT; <i>n</i> = 20; up to 12 sessions). Pain intensity was measured at baseline and fortnightly throughout the intervention. Trunk extension and flexion endurance, leg muscle strength and endurance, paraspinal muscle volume, cardio-respiratory fitness and self-report measures of kinesiophobia, disability and quality of life were assessed at baseline and 3- and 6-month follow-up. Pain intensity differed favoring MCMT between-groups at week 14 and 16 of treatment (both, <i>p</i> = 0.003), but not at 6-month follow-up. Both GSC (mean change (95%CI): −10.7 (−18.7, −2.8) mm; <i>p</i> = 0.008) and MCMT (−19.2 (−28.1, −10.3) mm; <i>p</i> < 0.001) had within-group reductions in pain intensity at six months, but did not achieve clinically meaningful thresholds (20mm) within- or between-group. At 6-month follow-up, GSC increased trunk extension (mean difference (95% CI): 81.8 (34.8, 128.8) s; <i>p</i> = 0.004) and flexion endurance (51.5 (20.5, 82.6) s; <i>p</i> = 0.004), as well as leg muscle strength (24.7 (3.4, 46.0) kg; <i>p</i> = 0.001) and endurance (9.1 (1.7, 16.4) reps; <i>p</i> = 0.015) compared to MCMT. GSC reduced disability (−5.7 (−11.2, −0.2) pts; <i>p</i> = 0.041) and kinesiophobia (−6.6 (−9.9, −3.2) pts; <i>p</i> < 0.001) compared to MCMT at 6-month follow-up. Multifidus volume increased within-group for GSC (<i>p</i> = 0.003), but not MCMT or between-groups. No other between-group changes were observed at six months. Overall, GSC improved trunk endurance, leg muscle strength and endurance, self-report disability and kinesiophobia compared to MCMT at six months. These results show that GSC may provide a more diverse range of treatment effects compared to MCMT.https://www.mdpi.com/2077-0383/9/6/1726exercisespinephysiotherapyphysical therapyrehabilitation |
| spellingShingle | Scott D. Tagliaferri Clint T. Miller Jon J. Ford Andrew J. Hahne Luana C. Main Timo Rantalainen David A. Connell Katherine J. Simson Patrick J. Owen Daniel L. Belavy Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes Journal of Clinical Medicine exercise spine physiotherapy physical therapy rehabilitation |
| title | Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes |
| title_full | Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes |
| title_fullStr | Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes |
| title_full_unstemmed | Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes |
| title_short | Randomized Trial of General Strength and Conditioning versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes |
| title_sort | randomized trial of general strength and conditioning versus motor control and manual therapy for chronic low back pain on physical and self report outcomes |
| topic | exercise spine physiotherapy physical therapy rehabilitation |
| url | https://www.mdpi.com/2077-0383/9/6/1726 |
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