title: Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain.
abstract: METHODS
  A prospective clinical randomized controlled trial.
  
  
  OBJECTIVE
  To determine the long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic and recurrent low back pain (LBP).
  
  
  BACKGROUND
  There is agreement on the importance of exercise during the course of chronic LBP. However, it is well known that long-term adherence with exercises is particularly low.
  
  
  METHODS
  A total of 93 patients with LBP were randomly assigned to the control group (standard exercise program) or the motivational group (combined exercise and motivational program). Follow-up assessments were performed at 3.5 weeks, 4 months, 12 months, and 5 years. Main outcome measures were disability scores, pain intensity, and working ability. In addition to classic statistics, the sophisticated linear partial credit model was used to test the effects of treatment on disability scores.
  
  
  RESULTS
  In both groups, significant improvements in the disability scores were found at all points of follow-up assessment, however, the cumulative effect of the treatment in the motivational group was more than twice as much as in the control group. This result is in accordance with the increasing divergence in pain intensity between groups between 12 months and 5 years after intervention. A significant, positive long-term effect at the 5-year reassessment in working ability was only seen in the motivational group. All statistically significant results were confirmed by intention-to-treat analyses.
  
  
  CONCLUSIONS
  Regarding long-term efficacy, the combined exercise and motivation program was superior to the standard exercise program. Five years after the supervised combined exercise and motivational program, patients had significant improvements in disability, pain intensity, and working ability.
authors.affiliation: Department of Orthopedic Pain Management, Orthopedic Hospital Speising, Vienna, Austria. martin.friedrich@oss.at
authors.forename: Martin
authors.initials: M
authors.lastname: Friedrich
authors.forename: Georg
authors.initials: G
authors.lastname: Gittler
authors.forename: Martin
authors.initials: M
authors.lastname: Arendasy
authors.forename: Klaus M
authors.initials: KM
authors.lastname: Friedrich
mesh_terms: D002908:Chronic Disease; D003131:Combined Modality Therapy; D037001:Directive Counseling / Q000379:methods*; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010147:Pain Measurement; D010349:Patient Compliance; D011446:Prospective Studies; D014938:Work Capacity Evaluation