Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial

Arch Phys Med Rehabil. 1998 May;79(5):475-87. doi: 10.1016/s0003-9993(98)90059-4.


Objective: To assess the effect of a combined exercise and motivation program on the compliance and level of disability of patients with chronic and recurrent low back pain.

Design: A double-blind prospective randomized controlled trial.

Setting: Physical therapy outpatient department, tertiary care.

Patients: Ninety-three low back pain patients were randomly assigned to either a standard exercise program (n = 49) or a combined exercise and motivation program (n = 44).

Interventions: Patients were prescribed 10 physical therapy sessions and were advised to continue exercising after treatment termination. The motivation program consisted of five compliance-enhancing interventions. Follow-up assessments were performed at 3 1/2 weeks, 4 months, and 12 months.

Main outcome measures: Disability (low back outcome score), pain intensity, physical impairment (modified Waddell score, fingertip-to-floor distance, abdominal muscle strength), working ability, motivation, and compliance.

Results: The patients in the motivation group were significantly more likely to attend their exercise therapy appointments (p = .0005). Four and 12 months after study entry there was a significant difference in favor of the motivation group with regard to the disability score (p = .004) and pain intensity (p < or = .026). At 4 months, there was a significant advantage for the motivation group in the fingertip-to-floor distance (p = .01) and in abdominal muscle strength (p = .018). No significant differences were found in motivation scores, self-reported compliance with long-term exercise, and modified Waddell score. In terms of working ability, there was a trend favoring the combined exercise and motivation program.

Conclusion: The combined exercise and motivation program increased the rate of attendance at scheduled physical therapy sessions, ie, short-term compliance, and reduced disability and pain levels by the 12-month follow-up. However, there was no difference between the motivation and control groups with regard to long-term exercise compliance.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Abdominal Muscles / physiology
  • Adult
  • Analysis of Variance
  • Chi-Square Distribution
  • Chronic Disease
  • Double-Blind Method
  • Exercise Therapy
  • Female
  • Follow-Up Studies
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Linear Models
  • Low Back Pain / rehabilitation*
  • Male
  • Middle Aged
  • Motivation
  • Pain Measurement
  • Patient Compliance
  • Physical Therapy Modalities
  • Prospective Studies
  • Tensile Strength
  • Treatment Outcome
  • Work Capacity Evaluation