title: [Inpatient multimodal pain therapy : Additive value of neuromuscular core stability exercises for chronic back pain].
abstract: BACKGROUND
  The medical and healthcare economic burden caused by chronic lumbar back pain (CLBP) requires the use of interdisciplinary treatment approaches. The present study aimed to evaluate whether the effectiveness of inpatient multimodal pain therapy (MPT, operations and procedures (OPS) coding 8-918.02), can be increased by implementing additional neuromuscular core stability exercises (NCSE).
  
  
  METHODS
  As part of a prospective controlled study, subjects with CLBP (n = 48, 17 males, 58.2 ± 11.7 years) were allocated to one of two groups. One group received standard care (SC, n =23) encompassing manual, pharmacological and psychological therapy in addition to passive physiotherapeutic applications. The intervention group (IG, n =25) additionally completed NCSE. On the day of admission and on discharge as well as 1 and 6 weeks after inpatient care, pain intensity (numeric rating scale), pain-related routine daily functions (Oswestry disability index), well-being (SF-12 Health Survey) and motor function parameters (trunk strength, endurance and postural control) were assessed. Data analysis was performed using statistical inference methods. In addition, effect sizes (Cohen's d) of intergroup differences were calculated.
  
  
  RESULTS
  Both groups showed significant reductions in pain intensity (p < 0.05, d > 0.6) at all measurement points (MP). Physical well-being and disability (p < 0.05, d > 0.6) were improved 1 week after discharge in the intervention group only. Overall, no systematic differences between groups were detected (p > 0.05). In relation to the motor outcomes, no significant changes over time nor between groups were verified (p > 0.05).
  
  
  CONCLUSIONS
  Despite the use of an additional NCSE, no significant added value in individuals with CLBP could be detected, although a systematic pre-post effect in daily functions and physical well-being (one week after discharge) was observed for the IG only. Therefore, on the basis of the study results, the implementation of additional NCSE into the inpatient MPT cannot be clearly recommended. To further delineate the therapeutic relevance, studies with larger sample sizes are needed.
authors.affiliation: Institut für Gesundheitssport & Public Health, Universität Leipzig, Leipzig, Deutschland. giesche@sport.uni-frankfurt.de.|Institut für Sportwissenschaften, Abteilung Sportmedizin, Goethe Universität Frankfurt, Ginnheimer Landstraße 39, 60487, Frankfurt am Main, Deutschland. giesche@sport.uni-frankfurt.de.
authors.forename: F
authors.initials: F
authors.lastname: Giesche
authors.affiliation: Institut für Gesundheitssport & Public Health, Universität Leipzig, Leipzig, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Streicher
authors.affiliation: Sana Kliniken Leipziger Land, Borna, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Maiwald
authors.affiliation: Institut für Gesundheitssport & Public Health, Universität Leipzig, Leipzig, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Wagner
mesh_terms: D000203:Activities of Daily Living / Q000145:classification / Q000523:psychology; D000328:Adult; D000368:Aged; D001416:Back Pain / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D056228:Feedback, Sensory; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D004856:Postural Balance; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology
keywords: Chronic low back pain; Core stability exercises; Inpatient multimodal pain therapy; Neuromuscular training; Sensorimotor training