How effective is a modified exercise program on its own or with back school in chronic low back pain? A randomized-controlled clinical trial

J Back Musculoskelet Rehabil. 2014;27(4):553-61. doi: 10.3233/BMR-140481.


Background and objectives: The aim of this trial is to search effectiveness of specifically adapted exercise programs on its own and with low back school on pain, disability, trunk and quadriceps muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP).

Material and method: A total of 121 patients with definite CLBP were included in this study. The patients were randomized into two groups. Group 1 (n=60) was given exercises only and accepted as the control group. Group 2 (n=61) received back school program and exercises. The exercise treatment was performed 3 days a week, for 3 months. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ), walking performance (6 minute walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk and knee muscle strength were measured with a handheld dynamometer. Patients were assessed at baseline (BT), at the end of treatment (AT), and at the six month follow-up (F).

Results: Statistically significant improvements were found between groups regarding all of the clinical parameters over time. Pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression of both groups also showed improvements AT. These improvements persisted at 6-months follow-ups (P < 0.05). There were statistically significant differences between the groups for pain, disability, muscle strength, endurance, 6MWT, QOL, and depression regarding the change scores between AT-BT test and F-BT test (P < 0.05). Group 2 improved more than group 1 except for mobility.

Conclusion: Exercise programs can be modified and used successfully in CLBP and this effect can be increased with addition of back school further.

Level of evidence: Diagnostic study Level-I-I (prospective study).

Keywords: Chronic low back pain; back school; depression; disability; endurance; exercise; muscle strength; pain; quality of life.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Chronic Disease
  • Depression / epidemiology
  • Disability Evaluation*
  • Exercise Therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Low Back Pain / physiopathology*
  • Low Back Pain / psychology
  • Low Back Pain / therapy*
  • Middle Aged
  • Muscle Strength / physiology
  • Pain Measurement
  • Patient Education as Topic*
  • Prospective Studies
  • Quality of Life / psychology
  • Severity of Illness Index*
  • Treatment Outcome
  • Walking / physiology