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Self-Report Measures Best Explain Changes in Disability Compared With Physical Measures After Exercise Rehabilitation for Chronic Low Back Pain

Marshall, Paul, PhD; Murphy, Bernadette, PhD

doi: 10.1097/BRS.0b013e31816233eb
Health Services Research

Study Design. Sixteen-week intervention for chronic patients with low back pain (LBP) with 9-month follow-up. Primary randomization at 4 weeks into either supervised Swiss ball exercise or an exercise advice group.

Objective. To evaluate changes in disability and pain in individuals with chronic LBP after combined treatment and exercise interventions, and to evaluate whether changes in self-report or physical measures would best explain improvements in disability

Summary of Background Data. There is a need to understand what the effectiveness of a clinically applicable treatment intervention is for an individual’s perception of their back pain. There is insufficient evidence about the different combinations of manual treatment that commonly precede involvement in exercise programs.

Methods. Sixty individuals with chronic nonspecific LBP (at least 3-month duration) were randomly assigned (after 4 weeks of manipulative or nonmanipulative treatment) to either a supervised Swiss ball exercise group, or an advice group. The exercise intervention was for 12 weeks with a long-term follow-up of 9 months. Self-report measures and physical measures (endurance times and myoelectric fatigue) were collected throughout the study.

Results. Self-rated disability improved more after the treatment period for individuals who received supervised exercise compared with advice alone. There was no difference found between individuals who received manipulative or nonmanipulative treatment. Multiple regression analysis found that self-report measures best explained improvements in disability throughout the study. Long-term findings showed no group differences.

Conclusion. Supervised exercise is a more successful subsequent to manual treatment compared with exercise advice. The improvements associated with this type of program were primarily manifested in the psychologic self-report measures rather than physical measurements.

This study evaluated whether supervised exercise after manipulative or nonmanipulative treatment is more effective than exercise advice alone. More rapid improvement was observed for individuals who received supervised training. There was no difference between individuals who received manipulative or nonmanipulative treatment before beginning the exercise intervention. Changes in self-report measures best explained improvements in disability.

From the Department of Sport and Exercise Science, University of Auckland, Auckland, New Zealand.

Acknowledgment date: January 19, 2007. Revision date: May 16, 2007. Acceptance date: August 2, 2007.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Paul Marshall, Department of Sport and Exercise Science, University of Auckland, Tamaki Campus, Private Bag 92019, Auckland, New Zealand; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.