title: Rest versus exercise as treatment for patients with low back pain and Modic changes. A randomized controlled clinical trial.
abstract: BACKGROUND
  Clinical experience suggests that many patients with Modic changes have relatively severe and persistent low back pain (LBP), which typically appears to be resistant to treatment. Exercise therapy is the recommended treatment for chronic LBP, however, due to their underlying pathology, Modic changes might be a diagnostic subgroup that does not benefit from exercise. The objective of this study was to compare the current state-of-the art treatment approach (exercise and staying active) with a new approach (load reduction and daily rest) for people with Modic changes using a randomized controlled trial design.
  
  
  METHODS
  Participants were patients from an outpatient clinic with persistent LBP and Modic changes. They were allocated using minimization to either rest therapy for 10 weeks with a recommendation to rest for two hours daily and the option of using a flexible lumbar belt or exercise therapy once a week for 10 weeks. Follow-up was at 10 weeks after recruitment and 52 weeks after intervention and the clinical outcome measures were pain, disability, general health and global assessment, supplemented by weekly information on low back problems and sick leave measured by short text message (SMS) tracking.
  
  
  RESULTS
  In total, 100 patients were included in the study. Data on 87 patients at 10 weeks and 96 patients at one-year follow-up were available and were used in the intention-to-treat analysis. No statistically significant differences were found between the two intervention groups on any outcome.
  
  
  CONCLUSIONS
  No differences were found between the two treatment approaches, 'rest and reduced load' and 'exercise and staying active', in patients with persistent LBP and Modic changes.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT00454792.
authors.affiliation: Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark. rikke.kruger.jensen@slb.regionsyddanmark.dk
authors.forename: Rikke K
authors.initials: RK
authors.lastname: Jensen
authors.forename: Charlotte
authors.initials: C
authors.lastname: Leboeuf-Yde
authors.forename: Niels
authors.initials: N
authors.lastname: Wedderkopp
authors.forename: Joan S
authors.initials: JS
authors.lastname: Sorensen
authors.forename: Claus
authors.initials: C
authors.lastname: Manniche
mesh_terms: D004185:Disability Evaluation; D005081:Exercise Therapy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006262:Health; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications* / Q000628:therapy*; D017116:Low Back Pain / Q000150:complications* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012146:Rest; D018582:Sick Leave; D016896:Treatment Outcome