Resistance Training Versus General Exercise In Multidisciplinary Rehabilitation Of Low Back Pain

PURPOSE: Chronic low back pain (CLBP) is commonly managed through multidisciplinary rehabilitation (MDR). We aimed to assess if the effectiveness of MDR could be improved by replacing general exercise (GE) with progressive resistance training (PRT) with high intensity using elastic bands. METHODS: Consenting adults (n=99) with moderate to severe non-specific CLBP were randomized to an intervention (PRT) or a comparative group (GE). Both groups received 3-weeks MDR with either GE or PRT (squats, stiff-legged deadlifts, flies, unilateral rows, reversed flies, lateral shoulder raises and lateral pulldown performed 3 times per week with resistance varying from 15-20 to 8-10 repetitions). Both groups were instructed to continue their respective exercise program for 9 weeks after completing the MDR, in which time participants were offered up to three supervised booster sessions. Researchers were blinded during data collection and analyses. The difference in change between groups at 12-weeks in pain-related disability (Oswestry disability index; ODI: 0-100) was the primary outcome. Secondary outcomes were pain (numerical pain rating scale), limitations in important activities (patient-specific functioning scale; PSFS: 0-10), health related quality of life, work ability, global perceived change, fear-avoidance beliefs and back-extension strength were secondary outcomes. RESULTS: Baseline data were missing for 25 patients due to early dropouts. Thus, data from 74 participants (mean age: 45 years, 57% women, mean ODI: 30.4) were obtained at baseline and included in the analyses. Forty-six persons participated at the 12-week follow-up test. There were no difference in change in ODI score between groups at 12 weeks (mean difference 1.6, 95% CI: -3.9-7.0, p=0.570, in favor of GE). The improvement in PSFS was larger in the GE group than in the PRT group (mean difference 1.4, 95% CI: 0.1-2.7, p=0.033). No significant differences between the groups were observed for the other secondary outcomes (p≥0.11). CONCLUSIONS: This study provided no evidence in support of replacing GE with PRT in MDR for CLBP. In fact, GE might be slightly more beneficial than PRT in reducing limitations in important activities.