Ferreira GE, Lin CC, Stevens ML, et al. Exercise Is Medicine, But Perhaps Not for Preventing Low Back Pain: A Randomized Trial of Exercise and Education to Prevent Low Back Pain Recurrence. J Orthop Sports Phys Ther. 2021 Apr;51(4):188-195. doi: 10.2519/jospt.2021.10187. (Original study)

OBJECTIVE: To assess whether an exercise and education program was more effective than an education booklet for preventing recurrence of low back pain (LBP).

DESIGN: Randomized controlled trial.

METHODS: Participants aged 18 years or older who had recovered from an episode of LBP within the previous week were recruited from primary care practices and the community. Participants were randomized to receive either 12 weeks of exercise and education (8 supervised exercise sessions and 3 one-on-one sessions) or a control (education booklet). The primary outcome was time to recurrence of LBP during the 1-year follow-up. Times to recurrence of LBP leading to activity limitation, care seeking, and work absence were secondary outcomes. Data were analyzed with Cox regression using intention-to-treat principles.

RESULTS: We planned to include 160 participants but included 111 (exercise and education, n = 57; educational booklet, n = 54). At the end of the study period, data completeness was 84.2%. Thirty-six (63%) participants in the exercise and education group and 31 (57%) participants in the control group had a recurrence of LBP. There was no statistically significant difference in time to recurrence of pain between groups (hazard ratio = 1.09; 95% confidence interval: 0.7, 1.8). There was no statistically significant effect for any of the secondary outcomes.

CONCLUSION: Among people recently recovered from LBP, exercise and education may not meaningfully reduce risk of recurrence compared to providing an educational booklet. J Orthop Sports Phys Ther 2021;51(4):188-195. doi:10.2519/jospt.2021.10187.

Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Physician 5 / 7
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Comments from MORE raters

Physician rater

This article has no new information. The study does not quite support their opening statement.

Physician rater

This study showed no benefit in low-back pain recurrence with a structured exercise program.

Rehab Clinician (OT/PT) rater

The study highlights the issue that without adherence to exercise, it is not possible to understand the impact of exercise versus other interventions. Finding ways to increase adherence are essential if we are to learn whether exercise actually works in real life, and not just in controlled experiments.

Rehab Clinician (OT/PT) rater

This is a relevant study for my understanding and knowledge base. This well designed study amplifies the difficulties of making progress and change in this patient group.
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