Exercise and Advice for LBP

This will be a trial that gets some attention in the coming weeks and months regarding the effectiveness of PT-prescribed exercise and advice for patients with LBP. It's a high quality, well controlled trial. The effects are moderate at 6 weeks, then tend to disappear at the 12-month follow-up. Although you can make an argument that insufficient efforts were made to sub-group patients and match treatment accordingly (hence perhaps smaller treatment effects), patients at least received a legitimate form of PT that resembles something close to being reasonable (as opposed to the typical heat, stretch, and hope protocol that has unfortunately been the mainstay of some previous high visbility studies of 'PT'). It will be interesting to see how this one plays out in the coming weeks and months.

John 

Comments

[Jon Newman]

I haven't obsessed sufficiently on this article yet but I'll at least start to add some thoughts. This study collected quite a bit of information so there is much to consider.

It's curious to me that more than 50% of the participants reported that they already engage in regular exercise. I'd be interested in what that consisted of. Perhaps the effect of adding more exercise (therapy) was buffered by this.

I enjoyed the addition of the appendix which described the exercise and advice (as well as the sham versions.) It would be nice to see this more frequently. That said, I found the education given to patients focused on mesodermal structures rather than trying to explain pain per se. Some of the information they gave was consistent with information I give however. It would be interesting to know if some education is more influential than other types. Also, it seemed that the education sessions were planned as a stand alone intervention on a given day versus worked into the course of treatment where "teachable moments" present themselves or when patients are in a particularly receptive mode.

Lastly, 60% of the participants had received treatment in the last 6 weeks (another potential buffering effect on additional treatment). I'd be interested in knowing what treatments these folks had previously as that would have happened in the "acute" stage for many of these folks.

That's a start.