title: Motor control or graded activity exercises for chronic low back pain? A randomised controlled trial Effects of a Three-Month Active Rehabilitation Program on Psychomotor Performance of Lower Limbs in Subjects with Low Back Pain: A Controlled Study with a Nine-Month Follow-up Does physical activity change predict functional recovery in low back pain? Protocol for a prospective cohort study Active rehabilitation for chronic low back pain: Cognitive-behavioral, physical, or both? First direct post-treatment results from a randomized controlled trial [ISRCTN22714229] Efficacy of percutaneous electrical nerve stimulation and therapeutic exercise for older adults with chronic low back pain: A randomized controlled trial Characterizing the course of low back pain: a latent class analysis. The Effectiveness of High-Intensity Versus Low-Intensity Back Schools in an Occupational Setting: A Pragmatic Randomized Controlled Trial Low Back Pain in a General Population. Natural Course and Influence of Physical Exercise–A 5-Year Follow-up of the Musculoskeletal Intervention Center-Norrtälje Study Graded Activity for Low Back Pain in Occupational Health Care The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status The course of chronic and recurrent low back pain in the general population Treatment-based subgroups of low back pain: a guide to appraisal of research studies and a summary of current evidence. Effects of two 4-week proprioceptive neuromuscular facilitation programs on muscle endurance, flexibility, and functional performance in women with chronic low back pain. The long-term effects of a self-management program for inner-city primary care patients with acute low back pain. Graded activity for workers with low back pain: who benefits most and how does it work? Sequentially allocated clinical trial of rhythmic stabilization exercises and TENS in women with chronic low back pain
abstract: Background Chronic low back pain remains a major health problem in Australia and around the world . Unfortunately the majority of treatments for this condition produce small effects because not all patients respond to each treatment . It appears that only 25–50 % of patients respond to exercise . The two most popular types of exercise for low back pain are grade d activity and motor control exercises . At present however , there are no guidelines to help clinicians select the best treatment for a patient . As a result , time and money are wasted on treatments which ultimately fail to help the patient . Methods This paper describes the protocol of a r and omised clinical trial comparing the effects of motor control exercises with a grade d activity program in the treatment of chronic non specific low back pain . Further analysis will identify clinical features that may predict a patient 's response to each treatment . One hundred and seventy two participants will be r and omly allocated to receive either a program of motor control exercises or grade d activity . Measures of outcome will be obtained at 2 , 6 and 12 months after r and omisation . The primary outcomes are : pain ( average pain intensity over the last week ) and function ( patient-specific functional scale ) at 2 and 6 months . Potential treatment effect modifiers will be measured at baseline . Discussion This trial will not only evaluate which exercise approach is more effective in general for patients will chronic low back pain , but will also determine which exercise approach is best for an individual patient . Trial registration Proper psychomotor performance is needed in work and in activities of daily living , but among subjects with low back pain this area has been studied Little . The present purpose was to evaluate the effect and permanence of a 3-mo . physical exercise program on the psychomotor performance of lower limbs in subjects with low back pain . The associations between psychomotor performance and intensity of low back pain and subjective disability were also evaluated . 90 subjects with nonspecific , subacute low back pain were assigned to one of the three groups : one given three months intensive training , one home exercise , or the control group . Four measurement sessions were made during the 1-yr . study . Psychomotor speed of lower limbs was analyzed with Choice Reaction Time , Movement Time , and Total Response Time . Flight Time of a vertical static jump was also measured . Muscle strength was assessed with conventional methods from trunk , lower limbs , and h and . Intensity of Current Back Pain was analyzed with the Borg scale . Subjective disability was evaluated with the Oswestry Index . Analysis showed that muscle strength and back pain intensity had associations with psychomotor performance but subjective disability or physical activity did not affect it noticeably . There were no changes in Choice Reaction Time , but Total Response Time and Movement Time decreased and Flight Time increased for all subjects . In the first postintervention measurement the home exercise group had significantly lower Movement Time than the intensively trained group . Back Pain Intensity decreased in both exercise groups for those subjects whose psychomotor performance values were below the mean value for the sample Background Activity advice and prescription are commonly used in the management of low back pain ( LBP ) . Although there is evidence for advising patients with LBP to remain active , facilitating both recovery and return to work , to date no research has assessed whether objective measurements of free living physical activity ( PA ) can predict outcome , recovery and course of LBP . Methods An observational longitudinal study will investigate  PA  levels in a cohort of community-dwelling working age adults with acute and sub-acute LBP . Each participant 's  PA level , functional status , mood , fear avoidance behaviours , and levels of pain , psychological distress and occupational activity  will be measured on three occasions during for 1 week periods at baseline , 3 months , and 1 year .  Physical activity levels  will be measured by self report , RT3 triaxial accelerometer , and activity recall question naires . The primary outcome measure of functional recovery will be the Rol and Morris Disability Question naire ( RMDQ ) . Free living PA levels and changes in functional status will be quantified in order to look at predictive relationships between levels and changes in free living PA and functional recovery in a LBP population . Discussion This research will investigate levels and changes in activity levels of an acute LBP cohort and the predictive relationship to LBP recovery . The results will assess whether occupational , psychological and behavioural factors affect the relationship between free living PA and LBP recovery . Results from this research will help to determine the strength of evidence supporting international guidelines that recommend restoration of normal activity in managing LBP.Trial registration [ Clinical Trial Registration Number , ACTRN12609000282280 Background The treatment of non-specific chronic low back pain is often based on three different models regarding the development and maintenance of pain and especially functional limitations : the deconditioning model , the cognitive behavioral model and the biopsychosocial model . There is evidence that rehabilitation of patients with chronic low back pain is more effective than no treatment , but information is lacking about the differential effectiveness of different kinds of rehabilitation . A direct comparison of a physical , a cognitive-behavioral treatment and a combination of both has never been carried out so far . Methods The effectiveness of active physical , cognitive-behavioral and combined treatment for  chronic non-specific low back pain compared with a waiting list control group was determined by performing a r and omized controlled trial in three rehabilitation centers . Two hundred and twenty three patients were r and omized , using concealed block r and omization to one of the following treatments , which they attended three times a week for 10 weeks : Active Physical Treatment ( APT ) , Cognitive-Behavioral Treatment ( CBT ) , Combined Treatment of APT and CBT ( CT ) , or Waiting List ( WL ) . The outcome variables were self-reported functional limitations , patient 's main complaints , pain , mood , self-rated treatment effectiveness , treatment satisfaction and physical performance including walking , st and ing up , reaching forward , stair climbing and lifting . Assessment s were carried out by blinded research assistants at baseline and immediately post-treatment . The data were analyzed using the intention-to-treat principle . Results For 212 patients , data were available for analysis . After treatment , significant reductions were observed in functional limitations , patient 's main complaints and pain intensity for all three active treatments compared to the WL . Also , the self-rated treatment effectiveness and satisfaction appeared to be higher in the three active treatments . Several physical performance tasks improved in APT and CT but not in CBT . No clinical ly relevant differences were found between the CT and APT , or between CT and CBT . Conclusion All three active treatments were effective in comparison to no treatment , but no clinical ly relevant differences between the combined and the single component treatments were found Abstract Chronic low back pain ( CLBP ) in older adults may be disabling and therapeutically challenging , largely because of the inefficacy and /or morbidity associated with traditional pain treatment . We conducted a r and omized controlled trial in 200 men and women ⩾ age 65 with CLBP to evaluate the efficacy of percutaneous electrical nerve stimulation ( PENS ) with and without general conditioning and aerobic exercise ( GCAE ) , for reducing pain and improving physical function . Participants were r and omized to receive ( 1 ) PENS , ( 2 ) control‐PENS ( brief electrical stimulation to control for treatment expectancy ) , ( 3 ) PENS + GCAE , or ( 4 ) control‐PENS + GCAE , twice a week for 6 weeks . All four groups experienced significantly reduced pain ( range −2.3 to −4.1 on the McGill Pain Question naire short form ) , improved self‐reported disability ( range −2.1 to −3.0 on Rol and scale ) and improved gait velocity ( 0.04–0.07 m/s ) , sustained at 6 months . The GCAE groups experienced significantly fewer fear avoidance beliefs immediately post‐intervention and at 6 months than non‐GCAE groups . There were no significant side effects . Since brief electrical stimulation ( i.e. , control‐PENS ) facilitated comparably reduced pain and improved function at 6 months as compared with PENS , the exact dose of electrical stimulation required for analgesia can not be determined . GCAE was more effective than PENS alone in reducing fear avoidance beliefs , but not in reducing pain or in improving physical function Underst and ing the course of back pain is important for clinicians and research ers , but analyses of longitudinal data from multiple time points are lacking . A prospect i ve cohort study of consecutive back pain consulters from five general practice s in the United Kingdom was carried out between 2001 and 2003 to identify groups defined by their pain pathways . Patients were sent monthly question naires for a year . Longitudinal latent class analysis was performed by using pain intensity scores for 342 consulters . Analysis yielded four clusters representing different pathways of back pain . Cluster 1 ( " persistent mild " ; n = 122 ) patients had stable , low levels of pain . Patients in cluster 2 ( " recovering " ; n = 104 ) started with mild pain , progressing quickly to no pain . Cluster 3 ( " severe chronic " ; n = 71 ) patients had permanently high pain . For patients in cluster 4 ( " fluctuating " ; n = 45 ) , pain varied between mild and high levels . Distinctive patterns for each cluster were maintained throughout follow-up . Clusters showed statistically significant differences in disability , psychological status , and work absence ( p < 0.001 ) . This is the first time , to the authors ' knowledge , that latent class analysis has been applied to longitudinal data on back pain patients . Identification of four distinct groups of patients improves underst and ing of the course of back pain and may provide a basis of classification for intervention Study Design . R and omized controlled trial . Objectives . To compare high- and low-intensity back schools with usual care in occupational health care . Summary of Background Data . The content and intensity of back schools vary widely and the method ologic quality of r and omized controlled trials is generally weak . Until now , no back school has proven to be superior for workers sick-listed because of subacute nonspecific low back pain . Methods . Workers ( n = 299 ) sick-listed for a period of 3 to 6 weeks because of nonspecific low back pain were recruited by the occupational physician and r and omly assigned to a high-intensity back school , a low-intensity back school , or care as usual . Outcome measures were days until return to work , total days of sick-leave , pain , functional status , kinesiophobia , and perceived recovery and were assessed at baseline and at 3 and 6 months of follow-up . Principal analyses were performed according to the intention-to-treat principle . Results . We r and omly allocated 299 workers . Workers in the low-intensity back school returned to work faster compared with usual care and the high-intensity back school , with hazard ratios of 1.4 ( P = 0.06 ) and 1.3 ( P = 0.09 ) , respectively . The comparison between high-intensity back school and usual care result ed in a hazard ratio of 1.0 ( P = 0.83 ) . The median number of sick-leave days was 68 , 75 , and 85 in the low-intensity back school , usual care , and high-intensity back school , respectively . Beneficial effects on functional status and kinesiophobia were found at 3 months in favor of the low-intensity back school . No substantial differences on pain and perceived recovery were found between groups . Conclusions . The low-intensity back school was most effective in reducing work absence , functional disability , and kinesiophobia , and more workers in this group scored a higher perceived recovery during the 6-month follow-up Study Design . A 5-year prospect i ve cohort study was conducted of men and women seeking care for a new period of low back pain ( LBP ) . Objectives . To study the natural course of pain and disability due to LBP during a 5-year follow-up period , and to investigate the possible influence of regular physical exercise on recovery . Summary of Background Data . LBP is major health problem , but its natural course is not very well studied . Several studies have investigated the role of physical exercise on LBP disorders , with inconsistent results . Methods . At baseline , a total of 790 subjects seeking care for LBP were interviewed about physical exercise during leisure time . Over 5 years , 3 follow-up assessment s were made by postal question naire . At all measuring points , pain intensity ratings and disability scores were compared between men and women , and among 3 exercise categories . Results . The pain intensity and disability scores were improved after 5 years for both men and women . The most prominent improvements occurred after 6 months , but less so thereafter . There were no significant differences between men and women with regard to individual changes at the 5-year follow-up concerning the pain intensity or disability scores . There were no significant differences , either for women or men , between low , median , or high intensity exercise groups regarding pain intensity or disability values for the individual change at the 5-year follow-up . Conclusions . Over a 5-year period , both men and women who had sought care for LBP reported a decrease in pain and disability ; however , only a few were fully restored . In this study , we found no effect of nonspecific physical exercise on recovery from LBP in men and women Context Low back pain causes frequent disability and lost productive time . Contribution This r and omized trial compared a behavioral-oriented grade d activity program with usual care in 134 Dutch airline company workers who had missed work because of persistent low back pain .  Grade d activity consisted of biweekly 1-hour exercise sessions with physiotherapists who emphasized operant-conditioning principles . Over 6 months of follow-up , participants in the grade d activity program missed 58 days of work , while participants receiving usual care missed 87 days . Implication s A behavioral-oriented grade d activity program returned participants with low back pain to work more often than did usual care . The Editors Nonspecific low back pain is an uncomfortable medical condition that causes frequent disability and absence from work . Most episodes of low back pain resolve fairly quickly and cause only short periods of absence from work . However , some workers with low back pain miss work for several days to weeks and are at risk for more permanent disability ( 1 ) . To reduce the individual and socioeconomic burden related to this absenteeism , we need effective intervention strategies in occupational health care setting s that promote safe and rapid return to work . One promising and often-advocated intervention strategy for workers with prolonged nonspecific low back pain is active rehabilitation that is directed toward return to normal activity and work ( 2 ) . Examples are grade d activity interventions that include physical exercise , application of operant-conditioning behavioral principals , and promotion of improved functioning and safe return to work even if pain persists ( 3 - 6 ) . In a r and omized , controlled trial , Lindstrm and colleagues ( 3 , 4 ) found that a grade d activity intervention reduced absence from work more than did traditional care in Swedish workers employed in the automobile industry . We investigate , in a second r and omized , controlled trial , whether absence from work because of low back pain is reduced more with grade d activity intervention than with traditional care in an occupational health care setting in the Netherl and s. Methods Study Design and Sample The study was a single-blind , r and omized , controlled trial in an occupational health services center ( KLM Health , Safety and Environment ) at Schiphol Airport , Amsterdam , the Netherl and s. The center provides occupational health services for all employees of a major Dutch airline ( KLM Royal Dutch Airlines ) . The source sample ( n = 20 000 ) consisted of workers who were employed in the following organizational units of the airline : baggage and aircraft turnaround services , passenger services , engineering and maintenance , cargo , and cabin and cockpit . Workers who were listed as absent from work because of low back pain were invited for a consultation with the occupational physician . Those who were thought to be eligible for inclusion were referred to the research assistant , who judged whether they met the inclusion criteria : full or partial absence from work because of nonspecific low back pain and low back pain symptoms with a minimum duration of 4 weeks in succession . The exclusion criteria were low back pain with radiation below the knee with signs of nerve-root compression ( 7 ) ; cardiovascular contraindications for physical activity , as checked according to the Physical Activities Readiness Question naire ( 8 , 9 ) ; any conflict between worker and employer with legal involvement ; or pregnancy . Workers who met the inclusion criteria were informed of the purpose and procedures of the study and were enrolled after giving informed consent . The Medical Ethical Committee of the VU University Medical Center , Amsterdam , the Netherl and s , approved the study . Treatment Allocation The participants were assigned to grade d activity or usual care on the basis of block r and omization , after prestratification for the organizational unit in the workplace from which they were recruited ( the 5 organizational units listed earlier ) and for the severity of pain symptoms ( scored on a scale of 0 to 10 ; severity scores were < 6 or 6 points ) . This result ed in a total of 10 strata . R and omized , permuted blocks of 4 allocations were generated for each stratum through a computer-generated r and om-sequence table . Opaque , sequentially numbered , sealed envelopes were prepared for each stratum by a research er who was not involved in enrolling the participants or assigning them to their groups . The envelopes contained a sheet of paper that indicated 1 of the 2 interventions . Participants learned their group assignments after a research assistant completed the baseline measurements and delivered the sealed envelopes . Blinding The research assistants who collected the data were blinded to the treatment allocation . All participants were repeatedly asked not to reveal any information about their treatment allocation . The participants and treatment providers were not blinded to treatment allocation . Interventions In the Dutch occupational health care system , occupational physicians guide disabled workers who are absent from work through their disability period . These occupational physicians are employed by occupational health services that are paid for by the companies . The occupational physicians adhere to back pain management strategies that consist of advising workers on ergonomics , prevention , and return-to-work schedules and advising and communicating with other stakeholders ( such as health care providers and representatives of the workplace ) . Disabled workers who participated in the present study were assigned to either grade d activity or usual care within the context of the Dutch occupational health care setting . Grade d Activity The intervention group received the usual guidance from the occupational physician about work-related problems and barriers to return to work as well as the grade d activity intervention supervised by a physiotherapist .  Three physiotherapists who worked in a private practice at Schiphol Airport provided the treatment according to the grade d activity protocol . Two of those physiotherapists were also trained as manual therapists , and 1 was also a human movement scientist . Before the study , the physiotherapists had been specifically trained to treat patients with low back pain according to behavioral principles . A research physiotherapist who was experienced in treating patients with chronic pain in rehabilitation centers instructed the physiotherapists in three 2-hour sessions and practice d patienttherapist interactions with them through role-play . Before the study , the physiotherapists treated several patients according to the grade d activity protocol to gain more experience . The physiotherapists made audiotapes of the intervention sessions before and during the study period . The contents of these audiotapes were assessed and discussed with the research physiotherapist in 3 additional meetings . Furthermore , the physiotherapists summarized the treatment after each session , and research ers used these summaries to review the sessions . The same physiotherapist treated participants each time , except for temporary st and -in sessions that were supervised by colleagues because of holidays or other reasons . Specific therapists were not systematic ally selected to treat specific participants ; selection was based on pragmatic reasons , such as the time available in the work schedules of the physiotherapists or the days of treatment preferred by the participants . Table 1 presents the concept and content of the grade d activity intervention . The intervention consisted of 1-hour exercise sessions that participants attended twice per week until they returned completely to regular work or until the maximum therapy duration of 3 months was reached . At the start of the intervention , the physiotherapist inquired about the participant 's medical history and completed a brief physical examination consisting of flexion , extension , and lateroflexion of the lumbar spine and a brief screening for nerve-root pain ( 10 ) . The purpose of the physical examination was to confirm the diagnosis of benign , nonspecific low back pain and to reduce participants ' fears about any presumed underlying disease . The participants were reassured that despite the annoying pain , nothing was seriously wrong with their backs . Subsequently , the physiotherapist and participant decided on a set of general exercises and individually tailored exercises . Both types of exercises had to be performed during each session . The general exercises were aerobic exercises , such as cycling or rowing , and strengthening exercises for large muscle groups , and most were carried out in a gym while using exercise equipment . The strengthening exercises were a floor abdominal sit-up exercise , a dynamic back extension exercise , a leg-press exercise , a latissimus pull-down exercise , and st and ing up from a low chair .  Participants in the grade d activity group had to perform not only these general exercises but also individually tailored exercises , which imitated physical tasks at work or difficult and painful activities of daily living . For example , a participant who reported back problems while lifting and moving suitcases from a luggage wagon into an airplane might be given an exercise to practice lifting and moving a suitcase with a certain number of repetitions . During the first 3 sessions , the maximal performance ( for example , the maximum number of repetitions ) was assessed for each exercise separately , and the average score for each exercise over the 3 sessions was used as a baseline value for specifying a gradually progressive exercise scheme . Subsequently , the participant was asked to propose a date for full return to regular work , which would consequently be the end point of the physical exercise program . Before returning to full regular work , participants could return to work with modified hours and duties . Advised by the physiotherapist , the participant & NA ; Fear‐avoidance beliefs have been identified as an important psychosocial variable in patients with chronic disability doe to low back pain . The importance of fear‐avoidance beliefs for individuals with acute low back pain has not been explored . Seventy‐eight subjects with work‐related low back pain of less than 3 weeks ' duration were studied .  Measurements of pain intensity , physical impairment , disability , nonorganic signs and symptoms , and depression were taken at the initial evaluation . Fear‐avoidance beliefs were measured with the  work and physical activity subscales of the Fear‐avoidance Beliefs Question naire .  Disability and work status were re‐assessed after 4 weeks of physical therapy . Patterns of correlation between fear‐avoidance beliefs and other concurrently‐measured variables were similar to those reported in patients with chronic low back pain . Fear‐avoidance beliefs did not explain a significant amount of the variability in initial disability levels after controlling for pain intensity and physical impairment . Fear‐avoidance beliefs about work were significant predictors of 4‐week disability and work status even after controlling for initial levels of pain intensity , physical impairment , and disability , and the type of therapy received . Fear‐avoidance beliefs are present in patients with acute low back pain , and may be an important factor in explaining the transition from acute to chronic conditions . Screening for fear‐avoidance beliefs may be useful for identifying patients at risk of prolonged disability and work absence & NA ; Using latent class analysis ( LCA ) , a previous study on patients attending primary care identified four courses of low back pain ( LBP ) over the subsequent 6 months . To date , no studies have used longitudinal pain recordings to examine the “ natural ” course of recurrent and chronic LBP in a population ‐based sample of individuals . This study examines the course of LBP in the general population and elaborates on the stability and criterion‐related validity of the clusters derived . A r and om sample of 400 individuals reporting LBP in a population ‐based study was asked to complete a comprehensive question naire at the start and end of the year 's survey , and 52 weekly pain diaries in between . The latter were analyzed using LCA . 305 individuals returned more than 50 % of the diaries . Four clusters were identified ( severe persistent , moderate persistent , mild persistent , and fluctuating ) . The clusters differed significantly with regards to pain and disability . Assessment of cluster stability showed that a considerable proportion of patients in the “ fluctuating ” group changed their classification over time . Three of the four clusters describing the typical course of pain matched the clusters described previously for patients in primary care . Due to the population ‐based design , this study achieves , for the first time , a close insight into the “ natural ” course of chronic and recurrent low back pain , including individuals that did not necessarily visit the general practitioner . The findings will help to underst and better the nature of this pain in the general population There has been a recent increase in research evaluating treatment-based subgroups of non-specific low back pain .  The aim of these sub-classification schemes is to identify subgroups of patients who will respond preferentially to one treatment as opposed to another . Our article provides accessible guidance on to how to interpret this research and determine its implication s for clinical practice . We propose that studies evaluating treatment-based subgroups can be interpreted in the context of a three-stage process : ( 1 ) hypothesis generation-proposal of clinical features to define subgroups ; ( 2 ) hypothesis testing-a r and omised controlled trial ( RCT ) to test that subgroup membership modifies the effect of a treatment ; and ( 3 ) replication-another RCT to confirm the results of stage 2 and ensure that findings hold beyond the specific original conditions . At this point , the bulk of research evidence in defining subgroups of patients with low back pain is in the hypothesis generation stage ; no classification system is supported by sufficient evidence to recommend implementation into clinical practice BACKGROUND AND PURPOSE Improving functional performance in patients with chronic low back pain is of primary importance . The purpose of this study was to examine the effects of 2 proprioceptive neuromuscular facilitation ( PNF ) programs on trunk muscle endurance , flexibility , and functional performance in subjects with chronic low back pain ( CLBP ) . SUBJECTS Eighty-six women ( 40.2+/-11.9 [ mean+/-SD ] years of age ) who had complaints of CLBP were r and omly assigned to 3 groups : rhythmic stabilization training , combination of isotonic exercises , and control . METHODS Subjects trained with each program for 4 weeks with the aim of improving trunk stability and strength . Static and dynamic trunk muscle endurance and lumbar mobility were measured before , at the end of , and 4 and 8 weeks after training . Disability and back pain intensity also were measured with the Oswestry Index . RESULTS Multivariate analysis of variance indicated that both training groups demonstrated significant improvements in lumbar mobility ( 8.6%-24.1 % ) , static and dynamic muscle endurance ( 23.6%-81 % ) , and Oswestry Index ( 29.3%-31.8 % ) measurements . DISCUSSION AND CONCLUSION Static and dynamic PNF programs may be appropriate for improving short-term trunk muscle endurance and trunk mobility in people with CLBP BACKGROUND We evaluated the effect of a self-management program for low-income primary care patients with acute low back pain ( ALBP ) from inner-city neighborhood health centers . METHODS We conducted a r and omized controlled trial of a self-management program compared with usual care at university-affiliated neighborhood health centers and an emergency department of an inner-city public teaching hospital . We enrolled 211 patients who visited a physician for ALBP ( < 90 days ' duration ) . The self-management program consisted of 3 group sessions and telephone follow-up that focused on underst and ing back pain , increasing physical activity , and dealing with fears and frustrations . RESULTS At baseline , 4 months , and 12 months , blinded interviewers assessed back pain physical function ( Rol and Disability Question naire ) , health status ( Arthritis Impact Measurement Scales ) , self-efficacy , and time spent in physical activity . Compared with patients receiving usual care , intervention patients reported significantly better scores on the Rol and Disability Question naire ( P = .009 ) , mental functioning ( P = .009 ) , self-efficacy to manage ALBP ( P = .03 ) , time spent in physical activity ( P = .047 ) , and reduced fears of movement/reinjury ( P = .005 ) after 12 months . CONCLUSION A self-management program can improve and maintain functional status , mental functioning , and self-efficacy to manage future symptoms for 1 year among primary care patients with ALBP living in the urban , inner city OBJECTIVE To identify subgroups of workers absent from work due to low back pain who are more or less likely to return to work earlier as a result of a grade d activity intervention  , and to investigate whether this intervention is effective in reducing pain-related fears and if so , whether these reductions in pain-related fears mediate return to work . METHODS A subgroup analysis was conducted on data from a previous r and omized controlled trial of 134 Dutch airline workers , which found that a behaviorally-oriented grade d activity intervention was more effective than usual care in stimulating return to work . The subgroup analyses added interaction terms to a Cox regression model that described the relationship between treatment allocation and return to work over 12 months of followup . Furthermore , we studied the effects of grade d activity on pain-related fears and added variables indicating a reduction in pain-related fears to the model in order to investigate their influence on return to work . RESULTS Statistically significant interactions were found for disability , fear-avoidance beliefs about physical activity , and fear-avoidance beliefs about work . No indication was found that the reduction in pain-related fears in the grade d activity group mediated more favorable return-to-work results in this group . CONCLUSION Workers who perceive their disability to be moderate and workers with moderate scores for fear-avoidance beliefs return to work more rapidly as a result of the grade d activity intervention than workers with higher scores . The return to work of workers receiving the grade d activity intervention is possibly independent from the reductions in pain-related fears caused by this intervention Objective : To examine the effectiveness of rhythmic stabilization exercises and transcutaneous electrical nerve stimulation ( TENS ) and their combination in treating women with chronic low back pain . Design : Sequentially allocated , single-blinded and controlled study , with a two-month follow-up . Setting : The data were collected in a patient rehabilitation setting . Subjects : A total of 92 women ( 34—46 years old ) with chronic low back pain were studied . Interventions : Sequential allocation was undertaken into four groups : ` rhythmic stabilization ' ( n=23 ) , ` rhythmic stabilization — TENS ' ( n=23 ) , TENS ( n=23 ) , and a placebo group ( n = 23 ) . Each programme lasted for four weeks . All outcome measures were assessed prior to , immediately after , four weeks and eight weeks post intervention . Main measures : Data were obtained on functional disability , pain intensity , trunk extension range of motion , dynamic endurance of trunk flexion and static endurance of trunk extension . Results : A total of 88 patients provided two-month follow-up data . The ` rhythmic stabilization ' and the ` rhythmic stabilization — TENS ' groups displayed statistically significant ( P<0.05 ) improvements in functional disability and pain intensity ( ranging from 21.2 to 42.8 % ) , trunk extension range of motion ( ranging from 6.5 to 25.5 % ) , dynamic endurance of trunk flexion and static endurance of trunk extension ( ranging from 13.5 to 74.3 % ) compared with the remaining groups . Conclusions : The rhythmic stabilization programmes result ed in more gains in women with chronic low back pain regarding the present outcome variables compared with the other groups ; therefore , its application in female chronic low back pain patients aged 34—46 years is recommended
target: That is , persons with acute or subacute LBP appear to vary in the levels of physical activity independent of their pain-related disability .
  Persons with chronic LBP with high levels of disability are also likely to have low levels of physical activity .
  Persons with acute or subacute back pain appear to vary in the levels of physical activity independent of disability .
  Persons with chronic back pain with high levels of disability will likely have low levels of physical activity
background: It is often assumed that patients with pain-related disability due to low back pain ( LBP ) will have reduced physical activity levels , but recent studies have provided results that challenge this assumption .
  The aim of our systematic review was to examine the relationship between  physical activity  and disability in LBP .