title: Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized controlled trial.
abstract: BACKGROUND
  Motor control exercises to improve control and coordination of trunk muscles and graded activity under the principles of cognitive-behavioral therapy are 2 commonly used exercise therapies, yet there is little evidence to support the use of one intervention over the other.
  
  
  OBJECTIVE
  The objective of this study was to compare the effectiveness of motor control exercises and graded activity for patients with chronic nonspecific low back pain.
  
  
  METHODS
  This study was a prospectively registered randomized controlled trial with outcome assessment and statistical analyses conducted blind to group.
  
  
  METHODS
  The study was conducted in primary care settings.
  
  
  METHODS
  The participants were 172 patients with chronic (>12 weeks) nonspecific low back pain.
  
  
  METHODS
  Patients were randomly assigned to receive either motor control exercises or graded activity. There was no attempt to subclassify patients to match them to a treatment. Patients in both groups received 14 sessions of individualized, supervised exercise therapy.
  
  
  METHODS
  Primary outcomes were average pain over the previous week (numeric rating scale) and function (Patient-Specific Functional Scale); secondary outcomes were disability (24-item Roland-Morris Disability Questionnaire), global impression of change (Global Perceived Effect Scale), and quality of life (36-Item Short-Form Health Survey questionnaire [SF-36]). Outcome measures were collected at baseline and at 2, 6, and 12 months after intervention.
  
  
  RESULTS
  A linear mixed models analysis showed that there were no significant differences between treatment groups at any of the time points for any of the outcomes studied. For example, the effect for pain at 2 months was 0.0 (-0.7 to 0.8).
  
  
  CONCLUSIONS
  Clinicians could not be blinded to the interventions.
  
  
  CONCLUSIONS
  results of this study suggest that motor control exercises and graded activity have similar effects for patients with chronic nonspecific low back pain.
authors.affiliation: Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada. lmacedo@ualberta.ca
authors.forename: Luciana Gazzi
authors.initials: LG
authors.lastname: Macedo
authors.forename: Jane
authors.initials: J
authors.lastname: Latimer
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Maher
authors.forename: Paul W
authors.initials: PW
authors.lastname: Hodges
authors.forename: James H
authors.initials: JH
authors.lastname: McAuley
authors.forename: Michael K
authors.initials: MK
authors.lastname: Nicholas
authors.forename: Lois
authors.initials: L
authors.lastname: Tonkin
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Stanton
authors.forename: Tasha R
authors.initials: TR
authors.lastname: Stanton
authors.forename: Ryan
authors.initials: R
authors.lastname: Stafford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D016014:Linear Models; D017116:Low Back Pain / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology; D010147:Pain Measurement; D011320:Primary Health Care; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D016896:Treatment Outcome