Chronische lage rugpijn: fysieke training, stapsgewijs opgevoerde activiteit met probleemoplossende training, of combinatie*

Objective

To examine whether a combination of a physical training and graded activity with problem solving training is more effective than either intervention alone, one year after the end of treatment.

Design

A randomized controlled clinical multicentre trial (www.controlled-trials.com; ISRCTN22714229).

Method

Patients aged 18-65 years with physical restrictions due to chronic non-specific lower back pain referred for rehabilitation treatment were randomized into clusters of 4 consecutive patients per participating rehabilitation centre. They received physical training (aerobic training and muscle strengthening training for the back extensors; APT), gradual resumption of activities based on operant-behavioural principles and problem solving training (CBT), a combination treatment of APT and CBT (CT), or a waiting list treatment (10 weeks without treatment). The primary outcome was to ascertain whether CT in comparison with APT and with CBT lead to a 2.5 point extra decrease in the score on the ‘Roland disability questionnaire’ adjusted for centre of treatment, cluster of 4 patients, and baseline scores. Secondary outcomes were patient-specific complaints, self-perceived improvement, pain, depression and performance of 6 physical tasks.

Results

223 patients were included in the study. Follow-up data at 1 year were only gathered for the active intervention participants (n = 172). For a year following the end of treatment all active interventions lead to a reduction in physical restriction and improvement of all secondary outcome measures, with the exception of pain. No significant differences in reduction of physical restriction between the combination treatment and each single intervention were found. Among the various secondary outcome measures, only one significant difference emerged, with the single interventions leading to higher self-perceived improvement than the combination treatment.

Conclusion

The combination treatment, in which physical training was integrated with graded activity with problem solving training, was not more effective for patients with chronic non-specific lower back pain than the single interventions.