Poster Presentation Sydney Spinal Symposium 2019

‘Buy-in’ for back pain, does individualisation matter? (#28)

Mitchell Gibbs 1 , Paul Marshall 1
  1. Western Sydney University, Glen Alpine, NSW, Australia

Low back pain is the greatest worldwide burden as measured in terms of disability-adjusted life years (1). While exercise is first line treatment for chronic low back pain (CLBP) (2), programming options confronting practitioners are numerous and confusing. Exercise for CLBP generally involves assessment of movement patterns and aspects of muscular function for the purpose of individualisation. However, it appears a general exercise program (GEP) achieves the same outcomes as an individualised exercise prescription (IEP) (3). As clinical outcomes appear no different, it is of interest to practitioners to understand if adherence is altered between modalities.

Adherence is a key determinant of short and long-term outcomes from exercise interventions for CLBP (3). Of concern, it is reported 50 to 70% of CLBP patients are not adherent to an exercise program (3,4). With no superior exercise modality, adherence becomes pragmatic for practitioners.

To better understand the impact individualisation on beliefs associated with adherence, as put forward by social cognitive theory, we conducted an 8-week randomised controlled trial with 30-participants. Participants were randomized to 8 weeks of an IEP or GEP. All participants attended one session per week with an exercise physiologist and 4 home based sessions. Clinical outcomes, barrier self-efficacy, and adherence were assessed before and after 8-weeks. Additionally, outcome expectations, self-efficacy, and intention were measured before and after the first session, and after 8-weeks. Measures after the first session observed if clinical assessment and informing the patient that the program was individualised manipulated beliefs compared to a GEP.

Beliefs after the first session were elevated in both groups. Adherence was high and similar. Clinical outcomes were similar with both groups showing significant reduction from baseline in disability (P ≤ .01 and P = .01). Thus, it appears an IEP is no more beneficial than a GEP for CLBP. Clinically, it appears a GEP is an intelligent choice for practitioners as it negates the need for clinical assessments, which appear to add no benefit to outcomes or adherence.

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  2. Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075–94.
  3. Marshall PWM, Kennedy S, Brooks C, Lonsdale C. Pilates exercise or stationary cycling for chronic nonspecific low back pain: does it matter? A randomized controlled trial with 6- month follow-up. Spine. 2013;38(15):E952–E9.
  4. Friedrich M, Gittler G, Halberstadt Y, Cermak T, Heiller I. Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial. Archives of physical medicine and rehabilitation. 1998;79(5):475–87.