title: Efficacy of Behavioural Graded Activity Compared with Conventional Exercise Therapy in Chronic Non-Specific Low Back Pain: Implication for Direct Health Care Cost.
abstract: BACKGROUND
  The relative efficacy of conventional exercise therapy (CET) and behavioural graded activity (BGA) has not been fully established to inform the preference in clinical practice.
  
  
  OBJECTIVE
  To compare CET and BGA on the treatment outcome of chronic non-specific low back pain (LBP).
  
  
  METHODS
  Participants were assigned into either BGA or CET group in this randomized feasibility intervention. The CET group received supervised exercise therapy while BGA group engaged in individually prescribed sub-maximal activities based on time-contingent principles. Interventions were carried out twice weekly and over a period of 12 weeks. Outcome measures were numerical rating scale and RAND 36-item health survey which were administered at baseline, week 4 and week 12. Health care cost questionnaire was also administered to evaluate physiotherapy cost after 12 weeks. Mixed design two-way ANOVA with level of significance set as priori at p<0.05 was used to compare both groups.
  
  
  RESULTS
  Seventy-seven and half percent (62) participants (CET=29 and BGA=33) with mean ages 45.0±12.2 and 43.1±13.2 years respectively, completed the study. Both groups improved significantly (p<0.001) during the intervention. However, there were no significant differences (p>0.05) between the treatment groups at any time points and for any measures assessed. Therapeutic benefits in both groups have bearing on direct health care costs.
  
  
  CONCLUSIONS
  The results indicate that CET and BGA have similar outcomes in patients with chronic nonspecific LBP with regard to the pain and quality of life. Effective application may however be hampered by the cost-related factors thus suggesting evaluation of health care system in Ghana.
authors.affiliation: Department of Physiotherapy, School of Biomedical and Allied Health Sciences, University of Ghana.
authors.forename: A I
authors.initials: AI
authors.lastname: Bello
authors.affiliation: Department of Physiotherapy, School of Biomedical and Allied Health Sciences, University of Ghana.
authors.forename: Jna
authors.initials: J
authors.lastname: Quartey
authors.affiliation: Department of Medicine, School of Medicine and Dentistry, University of Ghana.
authors.forename: M
authors.initials: M
authors.lastname: Lartey
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000191:economics / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy; D005260:Female; D005869:Ghana; D017048:Health Care Costs; D006801:Humans; D016014:Linear Models; D017116:Low Back Pain / Q000191:economics / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cognitive Therapy; Exercise Therapy; Pain; Quality of life; direct costs