A phase II pilot study comparing a home total body strengthening programme plus manual therapy with a standard physiotherapy exercise regimen plus manual therapy in the management of chronic low back pain

Abstract

Objectives

To conduct a phase II pilot randomized controlled trial (RCT) comparing a home total body strengthening programme plus manual therapy with a standard physiotherapy exercise regimen plus manual therapy for the management of non-specific chronic low back pain (CLBP) and determine the feasibility for a larger RCT.

Introduction

There is moderate evidence for exercise combined with manual therapy in the treatment of CLBP. Patients with CLBP have decreased muscle power and cardiac capacity due to their low activity levels that leads to a de-conditioning syndrome and pain. This de-conditioning syndrome may be best addressed by total body strengthening.

Methods

Thirteen patients with CLBP were allocated to two groups by block randomization. Group A was the home total body strengthening programme plus manual therapy and group B was the standard physiotherapy exercise regimen plus manual therapy. Both groups received a course of manual therapy and a specific home exercise programme for 3 months. Three outcome measures pre- and post-treatment were used measuring function, pain, and quality of life.

Results

The treatment programmes in this pilot study were implemented successfully with a dropout rate of 19%. All the outcome measures used in this pilot study were responsive to change. Both groups showed a clinically important difference to function following treatment as well as improvements to pain and health-related quality of life.

Conclusion

The small sample size was one of the weaknesses of this pilot study. The findings from this pilot study suggest a future RCT is feasible to determine whether a home total body strengthening programme plus manual therapy is an effective management strategy for CLBP.

Keywords:

• De-conditioning syndrome
• Exercise therapy
• Manual therapy
• Strengthening

Acknowledgements

I would like to thank Dr Fery Ghazi and Emily Goodlad for their help in this dissertation as my Academic and Clinical supervisors respectively. Finally, I would like to thank Elaine Atkins for leading and supporting the Society of Musculoskeletal Medicine Masters programme.