Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized controlled trial.

BACKGROUND Motor control exercises to improve control and coordination of trunk muscles and graded activity under the principles of cognitive-behavioral therapy are 2 commonly used exercise therapies, yet there is little evidence to support the use of one intervention over the other. OBJECTIVE The objective of this study was to compare the effectiveness of motor control exercises and graded activity for patients with chronic nonspecific low back pain. DESIGN This study was a prospectively registered randomized controlled trial with outcome assessment and statistical analyses conducted blind to group. SETTING The study was conducted in primary care settings. PATIENTS The participants were 172 patients with chronic (>12 weeks) nonspecific low back pain. INTERVENTIONS Patients were randomly assigned to receive either motor control exercises or graded activity. There was no attempt to subclassify patients to match them to a treatment. Patients in both groups received 14 sessions of individualized, supervised exercise therapy. MEASUREMENTS Primary outcomes were average pain over the previous week (numeric rating scale) and function (Patient-Specific Functional Scale); secondary outcomes were disability (24-item Roland-Morris Disability Questionnaire), global impression of change (Global Perceived Effect Scale), and quality of life (36-Item Short-Form Health Survey questionnaire [SF-36]). Outcome measures were collected at baseline and at 2, 6, and 12 months after intervention. RESULTS A linear mixed models analysis showed that there were no significant differences between treatment groups at any of the time points for any of the outcomes studied. For example, the effect for pain at 2 months was 0.0 (-0.7 to 0.8). LIMITATIONS Clinicians could not be blinded to the interventions. CONCLUSION results of this study suggest that motor control exercises and graded activity have similar effects for patients with chronic nonspecific low back pain.