title: Combined exercise and motivation program: effect on the compliance and level of disability of patients with chronic low back pain: a randomized controlled trial.
abstract: OBJECTIVE
  To assess the effect of a combined exercise and motivation program on the compliance and level of disability of patients with chronic and recurrent low back pain.
  
  
  METHODS
  A double-blind prospective randomized controlled trial.
  
  
  METHODS
  Physical therapy outpatient department, tertiary care.
  
  
  METHODS
  Ninety-three low back pain patients were randomly assigned to either a standard exercise program (n = 49) or a combined exercise and motivation program (n = 44).
  
  
  METHODS
  Patients were prescribed 10 physical therapy sessions and were advised to continue exercising after treatment termination. The motivation program consisted of five compliance-enhancing interventions. Follow-up assessments were performed at 3 1/2 weeks, 4 months, and 12 months.
  
  
  METHODS
  Disability (low back outcome score), pain intensity, physical impairment (modified Waddell score, fingertip-to-floor distance, abdominal muscle strength), working ability, motivation, and compliance.
  
  
  RESULTS
  The patients in the motivation group were significantly more likely to attend their exercise therapy appointments (p = .0005). Four and 12 months after study entry there was a significant difference in favor of the motivation group with regard to the disability score (p = .004) and pain intensity (p < or = .026). At 4 months, there was a significant advantage for the motivation group in the fingertip-to-floor distance (p = .01) and in abdominal muscle strength (p = .018). No significant differences were found in motivation scores, self-reported compliance with long-term exercise, and modified Waddell score. In terms of working ability, there was a trend favoring the combined exercise and motivation program.
  
  
  CONCLUSIONS
  The combined exercise and motivation program increased the rate of attendance at scheduled physical therapy sessions, ie, short-term compliance, and reduced disability and pain levels by the 12-month follow-up. However, there was no difference between the motivation and control groups with regard to long-term exercise compliance.
authors.affiliation: Department of Orthopedic Physiotherapy, Orthopedic Hospital Speising, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Friedrich
authors.forename: G
authors.initials: G
authors.lastname: Gittler
authors.forename: Y
authors.initials: Y
authors.lastname: Halberstadt
authors.forename: T
authors.initials: T
authors.lastname: Cermak
authors.forename: I
authors.initials: I
authors.lastname: Heiller
mesh_terms: D000009:Abdominal Muscles / Q000502:physiology; D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002908:Chronic Disease; D004311:Double-Blind Method; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D017116:Low Back Pain / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010147:Pain Measurement; D010349:Patient Compliance; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D013718:Tensile Strength; D016896:Treatment Outcome; D014938:Work Capacity Evaluation