The efficacy of active rehabilitation in chronic low back pain - Effect onpain intensity, self-experienced disability, and lumbar fatigability

Study Design. A randomized study comparing the results of active rehabilita tion and passive control treatment in patients with chronic low back pain w ith follow-up at 6 months and 1 year. Objectives. To study the efficacy of active rehabilitation on pain, self-ex perienced disability, and lumbar fatigability. Summary of Background Data. Exercises in an outpatient setting are widely u sed for the treatment of chronic low back pain. The efficacy of the active rehabilitation approach has been documented in randomized control studies, but these studies have seldom been focused on lumbar fatigability, which is now recognized as a frequent problem among patients with chronic low back pain. Methods. Fifty-nine middle-aged patients (37 men and 22 women) with nonspec ific chronic low back pain were randomly assigned to 12 weeks' active rehab ilitation or to a passive control treatment (massage, thermal therapy). Pai n and disability index, low back pain intensity (visual analog scale, 100 m m), and the objectively assessed lumbar muscle fatigability (spectral elect romyogram, mean power frequency slope [MPFSLOPE]) in a new 90-second submax imal isoinertial back endurance test were recorded before and after the int erventions and at 6-month and 1-year follow-up visits. Results. Results of repeated measures multivariate analysis of variance ind icated that back pain intensity (visual analog scale) and functional disabi lity (pain and disability index score) decreased, and lumbar endurance (MPF SLOPE) improved significantly more (P < 0.05) in the active rehabilitation group than in the passive control treatment group, when measured at a 1-yea r follow-up examination. The group difference in visual analog scale and pa in and disability index changes became even more significant at the end of 1 year. The change in lumbar endurance was significantly greater in the act ive rehabilitation group than in the passive control treatment group at the 6-month follow-up, but not at the 1-year follow-up. Conclusions. The active progressive treatment program was more successful i n reducing pain and self-experienced disability and also in improving lumba r endurance than was the passive control treatment. However, the group diff erence in lumbar endurance tended to diminish at the 1-year follow-up.