Macedo LG, Latimer J, Maher CG, et al. “Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized controlled trial.” Phys Ther. 2012;92:363–377.

Background Current treatments for low back pain have small effects. A research priority is to identify patient characteristics associated with larger effects for specific interventions. Objective The aim of this study was to identify simple clinical characteristics of patients with chronic low back pain who would benefit more from either motor control exercises or graded activity. Design This study was a secondary analysis of the results of a randomized controlled trial. Methods One hundred seventy-two patients with chronic low back pain were enrolled in the trial, which was conducted in Australian physical therapy clinics. The treatment consisted of 12 initial exercise sessions over an 8-week period and booster sessions at 4 and 10 months following randomization. The putative effect modifiers (psychosocial features, physical activity level, walking tolerance, and self-reported signs of clinical instability) were measured at baseline. Measures of pain and function (both measured on a 0–10 scale) were taken at baseline and at 2, 6, and 12 months by a blinded assessor. Results Self-reported clinical instability was a statistically significant and clinically important modifier of treatment response for 12-month function (interaction: 2.72; 95% confidence interval=1.39 to 4.06). Participants with high scores on the clinical instability questionnaire (≥9) did 0.76 points better with motor control exercises, whereas those who had low scores (<9) did 1.93 points better with graded activity. Most other effect modifiers investigated did not appear to be useful in identifying preferential response to exercise type. Limitations The psychometric properties of the instability questionnaire have not been fully tested. Conclusions A simple 15-item questionnaire of features considered indicative of clinical instability can identify patients who respond best to either motor control exercises or graded activity.

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Effect of Motor Control Exercises Versus Graded Activity in Patients With Chronic Nonspecific Low Back Pain: A Randomized Controlled Trial

Physical Therapy ◽

10.2522/ptj.20110290 ◽

2012 ◽

Vol 92 (3) ◽

pp. 363-377 ◽

Cited By ~ 111

Author(s):

Luciana Gazzi Macedo ◽

Jane Latimer ◽

Christopher G. Maher ◽

Paul W. Hodges ◽

James H. McAuley ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Controlled Trial ◽

Patient Specific ◽

Low Back ◽

Randomized Controlled ◽

Supervised Exercise ◽

Graded Activity

BackgroundMotor 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.ObjectiveThe objective of this study was to compare the effectiveness of motor control exercises and graded activity for patients with chronic nonspecific low back pain.DesignThis study was a prospectively registered randomized controlled trial with outcome assessment and statistical analyses conducted blind to group.SettingThe study was conducted in primary care settings.PatientsThe participants were 172 patients with chronic (>12 weeks) nonspecific low back pain.InterventionsPatients 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.MeasurementsPrimary 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.ResultsA 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).LimitationsClinicians could not be blinded to the interventions.ConclusionThe results of this study suggest that motor control exercises and graded activity have similar effects for patients with chronic nonspecific low back pain.

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Comparing Pain Neuroscience Education Followed by Motor Control Exercises With Group‐Based Exercises for Chronic Low Back Pain: A Randomized Controlled Trial

Pain Practice ◽

10.1111/papr.12963 ◽

2020 ◽

Author(s):

Pouya Rabiei ◽

Bahram Sheikhi ◽

Amir Letafatkar

Keyword(s):

Randomized Controlled Trial ◽

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Chronic Low Back Pain ◽

Controlled Trial ◽

Low Back ◽

Randomized Controlled ◽

Neuroscience Education

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A randomized controlled trial comparing McKenzie therapy and motor control exercises on the recruitment of trunk muscles in people with chronic low back pain: a trial protocol

Physiotherapy ◽

10.1016/j.physio.2014.07.001 ◽

2015 ◽

Vol 101 (2) ◽

pp. 232-238 ◽

Cited By ~ 9

Author(s):

Mark H. Halliday ◽

Paulo H. Ferreira ◽

Mark J. Hancock ◽

Helen A. Clare

Keyword(s):

Randomized Controlled Trial ◽

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Chronic Low Back Pain ◽

Controlled Trial ◽

Trunk Muscles ◽

Trial Protocol ◽

Low Back ◽

Randomized Controlled

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Faculty Opinions recommendation of Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1119314.575494 ◽

2008 ◽

Author(s):

Steven George

Keyword(s):

Randomized Controlled Trial ◽

Low Back Pain ◽

Back Pain ◽

Controlled Trial ◽

Low Back ◽

Randomized Controlled ◽

Graded Activity ◽

Exposure In Vivo ◽

Pain Patients

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Motor Control Exercises, Sling Exercises, and General Exercises for Patients With Chronic Low Back Pain: A Randomized Controlled Trial With 1-Year Follow-up

Physical Therapy ◽

10.2522/ptj.20090421 ◽

2010 ◽

Vol 90 (10) ◽

pp. 1426-1440 ◽

Cited By ~ 82

Author(s):

Monica Unsgaard-Tøndel ◽

Anne Margrethe Fladmark ◽

Øyvind Salvesen ◽

Ottar Vasseljen

Keyword(s):

Randomized Controlled Trial ◽

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Outcome Measures ◽

Chronic Low Back Pain ◽

Controlled Trial ◽

Low Back ◽

Randomized Controlled

BackgroundExercise benefits patients with chronic nonspecific low back pain; however, the most effective type of exercise remains unknown.ObjectiveThis study compared outcomes after motor control exercises, sling exercises, and general exercises for low back pain.DesignThis was a randomized controlled trial with a 1-year follow-up.SettingThe study was conducted in a primary care setting in Norway.PatientsThe participants were patients with chronic nonspecific low back pain (n=109).InterventionsThe interventions in this study were low-load motor control exercises, high-load sling exercises, or general exercises, all delivered by experienced physical therapists, once a week for 8 weeks.MeasurementsThe primary outcome measure was pain reported on the Numeric Pain Rating Scale after treatment and at a 1-year follow-up. Secondary outcome measures were self-reported activity limitation (assessed with the Oswestry Disability Index), clinically examined function (assessed with the Fingertip-to-Floor Test), and fear-avoidance beliefs after intervention.ResultsThe postintervention assessment showed no significant differences among groups with respect to pain (overall group difference) or any of the outcome measures. Mean (95% confidence interval) group differences for pain reduction after treatment and after 1 year were 0.3 (−0.7 to 1.3) and 0.4 (−0.7 to 1.4) for motor control exercises versus sling exercises, 0.7 (−0.6 to 2.0) and 0.3 (−0.8 to 1.4) for sling exercises versus general exercises, and 1.0 (−0.1 to 2.0) and 0.7 (−0.3 to 1.7) for motor control exercises versus general exercises.LimitationsThe nature of the interventions made blinding impossible.ConclusionsThis study gave no evidence that 8 treatments with individually instructed motor control exercises or sling exercises were superior to general exercises for chronic low back pain.

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