title: Graded group exercise and fear avoidance behavior modification in the treatment of chronic low back pain.
abstract: BACKGROUND
  Approaches in the treatment of general chronic low back pain (CLBP) are multifaceted relative to specific interventions. In the past, passive interventions have commonly been employed with little evidence to support their effectiveness. Recent reviews suggest a focus on active exercises programs that includes pain education and cognitive behavioral therapy.
  
  
  OBJECTIVE
  To investigate the outcomes of CLBP patients and describe the approach in persons undergoing a group spinal rehabilitation program using graded exercise, and operant conditioning.
  
  
  METHODS
  Adult patients with CLBP participated in a twice weekly 90 minute exercise sessions for 8-weeks (n= 201). The program consisted of behavioral education, stretching, aerobic exercises, graded progressive resistance exercise, MedX isotonic strengthening, and functional bending lifting task exercises.
  
  
  RESULTS
  A total of 201 patient records were evaluated where the overall ODI improvement was 13.2% (± 14.0) (p< 0.001). There were significant and clinically meaningful improvements in flexibility, VAS, functional lifting tasks (p< 0.001), and lumbar extension strength (p= 0.01) at 8-week follow-up. Questionnaires were delivered via mail with a 21% return rate revealed sustained improvements.
  
  
  CONCLUSIONS
  CLBP patients undergoing an 8-week intensive exercise approach incorporating both behavioral and physical conditioning principles showed both significant and clinically significant improvements in this observational case series. Long-term benefits were also seen in both the 6 and 12 month follow-up questionnaires although further investigation is warranted due to limited survey return rate and study design.
authors.affiliation: Physical Therapy Program, College of St. Scholastica, Duluth, MN, USA.
authors.forename: Jena B
authors.initials: JB
authors.lastname: Ogston
authors.affiliation: Sports Medicine, Essentia Health, Duluth, MN, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Crowell
authors.affiliation: Occupational Medicine, Essentia Health, Duluth, MN, USA.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Konowalchuk
mesh_terms: D001362:Avoidance Learning; D059350:Chronic Pain / Q000523:psychology / Q000628:therapy*; D003216:Conditioning, Operant; D005081:Exercise Therapy; D005239:Fear; D005260:Female; D006126:Group Processes; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D064232:Visual Analog Scale
keywords: Kinesiophobia; Oswestry; chronic low back pain; graded exercise; group therapy; operant conditioning; rehabilitation