title: Aquatic exercise and pain neurophysiology education versus aquatic exercise alone for patients with chronic low back pain: a randomized controlled trial.
abstract: OBJECTIVE
  The aim of this study was to compare the effectiveness of a combination of aquatic exercise and pain neurophysiology education with aquatic exercise alone in chronic low back pain patients.
  
  
  METHODS
  Single-blind randomized controlled trial.
  
  
  METHODS
  Outpatient clinic.
  
  
  METHODS
  Sixty-two chronic low back pain patients were randomly allocated to receive aquatic exercise and pain neurophysiology education (n = 30) or aquatic exercise alone (n = 32).
  
  
  METHODS
  Twelve sessions of a 6-week aquatic exercise programme preceded by 2 sessions of pain neurophysiology education. Controls received only 12 sessions of the 6-week aquatic exercise programme.
  
  
  METHODS
  The primary outcomes were pain intensity (Visual Analogue Scale) and functional disability (Quebec Back Pain Disability Scale) at the baseline, 6 weeks after the beginning of the aquatic exercise programme and at the 3 months follow-up. Secondary outcome was kinesiophobia (Tampa Scale of Kinesiophobia).
  
  
  RESULTS
  Fifty-five participants completed the study. Analysis using mixed-model ANOVA revealed a significant treatment condition interaction on pain intensity at the 3 months follow-up, favoring the education group (mean SD change: -25.4± 26.7 vs -6.6 ± 30.7, P < 0.005). Although participants in the education group were more likely to report perceived functional benefits from treatment at 3 months follow-up (RR=1.63, 95%CI: 1.01-2.63), no significant differences were found in functional disability and kinesiophobia between groups at any time.
  
  
  CONCLUSIONS
  This study's findings support the provision of pain neurophysiology education as a clinically effective addition to aquatic exercise.
authors.affiliation: Polytechnic Institute of Castelo Branco - Physiotherapy Department, School of Health Care, Castelo Branco, Portugal diogo.pires@ipcb.pt.
authors.forename: Diogo
authors.initials: D
authors.lastname: Pires
authors.affiliation: Polytechnic Institute of Setúbal - Physiotherapy Department, School of Health Care, Setúbal, Portugal.
authors.forename: Eduardo Brazete
authors.initials: EB
authors.lastname: Cruz
authors.affiliation: Polytechnic Institute of Setúbal - Physiotherapy Department, School of Health Care, Setúbal, Portugal.
authors.forename: Carmen
authors.initials: C
authors.lastname: Caeiro
mesh_terms: D059350:Chronic Pain / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009424:Nervous System Physiological Phenomena; D059408:Pain Management / Q000379:methods*; D016037:Single-Blind Method; D014867:Water
chemical_list: D014867:Water
keywords: Education; chronic low back pain; disability; exercise; pain