title: The comparative effectiveness of a multimodal program versus exercise alone for the secondary prevention of chronic low back pain and disability.
abstract: OBJECTIVE
  The objective of this study was to examine whether a multimodal, secondary prevention program (MP) is superior to a general physical exercise program (EP) in influencing the process leading to chronic low back pain (LBP) in nurses with a history of back pain.
  
  
  METHODS
  The study was conducted as a randomized controlled parallel-group trial.
  
  
  METHODS
  The interventions were performed in a single center at the Department of Physical and Rehabilitation Medicine at the University of Munich in Germany.
  
  
  METHODS
  A total of 235 nurses from 14 nearby hospitals and nursing homes who experienced at least one episode of back pain during the previous 2 years were invited into the study. Of these, 183 nurses were enrolled and 169 (83 in the MP and 86 in the EP) qualified for the intent-to-treat analysis.
  
  
  METHODS
  The EP consisted of 11 group sessions, each lasting 1 hour. After introductory sessions, subsequent sessions included general physical strengthening and stretching exercises as well as instructions for a home-training program. The MP consisted of 17 group sessions of 1.75 hours and one individual session of 45 minutes. In addition to the full EP, the MP included 5 psychological units, 7 segmental stabilization exercises units, and 8 ergonomic and workplace-specific units.
  
  
  METHODS
  The primary study end-point variable was pain interference, and the secondary study end-point variables were pain intensity and functioning as measured with the West Haven-Yale Multidimensional Pain Inventory and the Short Form-36, respectively. These study end-point variables were defined a priori.
  
  
  RESULTS
  There was no statistically significant difference between the 2 groups. Small-to-moderate effects were observed in both intervention programs across all study end-point variables. For pain interference, the effect size at 12 months after intervention was 0.58 in the MP and 0.47 in the EP.
  
  
  CONCLUSIONS
  A multimodal program is not superior to a general exercise program in influencing the process leading to chronic LBP in a population of nurses with a history of pain. The most likely explanation is a common psychological mechanism leading to improved pain interference that is irrespective of the program used. Considering the lower resources of the general exercise program, the expense for a multimodal program is not justified for the secondary prevention of LBP and disability.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ewert
authors.forename: Heribert
authors.initials: H
authors.lastname: Limm
authors.forename: Tina
authors.initials: T
authors.lastname: Wessels
authors.forename: Berid
authors.initials: B
authors.lastname: Rackwitz
authors.forename: Katharina
authors.initials: K
authors.lastname: von Garnier
authors.forename: Robert
authors.initials: R
authors.lastname: Freumuth
authors.forename: Gerold
authors.initials: G
authors.lastname: Stucki
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003131:Combined Modality Therapy; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000517:prevention & control* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009126:Muscle Relaxation; D009726:Nurses; D009788:Occupational Therapy; D010353:Patient Education as Topic; D012064:Relaxation Therapy; D055502:Secondary Prevention; D013315:Stress, Psychological / Q000628:therapy