Huber D, Grafetstatter C, Prossegger J, et al. Green exercise and mg-ca-SO4 thermal balneotherapy for the treatment of non-specific chronic low back pain: a randomized controlled clinical trial. BMC Musculoskelet Disord. 2019 May 17;20(1):221. doi: 10.1186/s12891-019-2582-4. (Original study)

BACKGROUND: Non-specific chronic low back pain (nscLBP) has a high socio-economic relevance due to its high incidence, prevalence and associated costs. Therefore, it is essential to evaluate effective therapeutic strategies. This study examines the effects of moderate mountain exercise and spa therapy on orthopedic and psychophysiological parameters. Based on a three-armed randomized controlled trial, guided mountain hiking tours and balneotherapy in thermal water were compared to a control group.

METHODS: Eighty patients with diagnosed nscLBP were separated into three groups: The two intervention groups GE (green exercise) and GEBT (green exercise and balneotherapy) undertook daily mountain hiking tours, whereas the GEBT group got an additional treatment with baths in Mg-Ca-SO4 thermal water. The third group (CO) received no intervention. GE and GEBT group were treated for 6 days; all groups were followed up for 120 days.

RESULTS: Compared to GE and CO group, the GEBT treatment showed significant improvements of pain, some orthopedic parameters, health-related quality of life and mental well-being in patients with nscLBP.

CONCLUSIONS: The results of this study confirmed a benefit of mountain hiking combined with Mg-Ca-SO4 spa therapy as a multimodal treatment of patients with nscLBP. Further studies should focus on long-term-effects of this therapeutic approach.

TRIAL REGISTRATION: ISRCTN, ISRCTN99926592 . Registered 06. July 2018 - Retrospectively registered.

Discipline Area Score
Physician 4 / 7
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Comments from MORE raters

Physician rater

There are no long term outcomes and inadequate description of randomisation and blinding (if any).

Physician rater

Randomised controlled trial of treatment for chronic low-back pain with three treatment arms: one group got only the exercise program, the second group got the exercise program and 20 minutes balneotherapy. The control group was a non-intervention waiting-list group. Treatment period was for 8 days, follow-up at 120 days. Both active treatment groups had significant benefits over the control group, with more benefits for the exercise and balneotherapy group. Main concerns about this study is the short treatment period and the short duration of follow-up for what is a chronic long-term pain disorder. It is too early to recommend this as an effective therapy for chronic low-back pain and more studies with more patients are needed, preferably with longer treatment periods and definitely with longer follow-up.

Physician rater

Good piece of research to help guide patients towards exercise with some therapy support afterwards with no record of harm to put my patients off.
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