A study published in the 2015 in Manual Therapy examined the effects of
graded activity versus physiotherapy in patients with chronic low back pain in
a randomized controlled trial. 66
patients with chronic nonspecific low back pain were recruited from Specialized
Rehabilitation Services at Taboão de Serra in Sao Paulo, Brazil. The participants were all between the ages of
10 to 65 years, and had a minimum pain intensity score of three in the 11-point
Pain Numerical Rating Scale. Before the
intervention treatment, the patients were screened by a physiotherapist who
assessed pain intensity and disability, along with secondary outcomes such as
quality of pain, quality of life, global perceived effect, return to work,
physical activity, physical capacity, and kinesiophobia.
For the intervention, the patients
were randomized into either the Graded Activity Group or Physiotherapy Exercise
Group. Both groups went to hourly sessions
twice a week for six weeks, for a total of 12 1-hour sessions. The
physiotherapy group performed stretching exercises that focused on the erector
spinae, hamstrings, and triceps surae as well as strengthening exercises
focusing on the rectus abdominus, abdominus obliques internus, and abdominus
obliques externus. They also performed
motor control exercises focusing on the TrA and lumbar multifidus muscles.
The Graded Activity Group followed
a program that consisted of individual sessions of progressive and sub-maximal
exercises that aim to improve physical fitness and stimulate changes in
behavior and attitude. They performed
aerobic training on a treadmill and lower limb and trunk strengthening
exercises. The patients also selected
one or two activities that they considered difficult and received guidance on
these throughout the treatment. They
also received an educational booklet with information on how to take care of
the spine.
The results
showed significant improvements in all outcome measures of both groups, with a
non-significant difference between the groups. This study provided evidence
that both graded activity and physiotherapy were effective for patients with
chronic nonspecific low back pain.
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