Restorative Exercise
for Clinical Low Back Pain
A Prospective Two-Center Study With 1-Year Follow-Up
Spine 1999;24:889-898
Scott Leggett, MS.
ESS.* Vert Mooney, MD., Leonard N. Matheson. PhD, Brian
Nelson, MD, Ted Dreisinger,
PhD. Jill Van Zytveld, BA, and L. Vie. BA
Study Design.
A comparison of treatment of 412 patients with chronic
back pain at two separate centers using the same treatment
protocols and outcome measures. Outcome was defined
by specific strength testing; Short Form-36 scores
at intake, discharge, and 1-year follow-up; self-appraisal
of improvement at discharge and in a 1-year follow-up;
and reuse of health care services after discharge.
Objectives. To investigate the efficacy of
standardized treatment methods using isolated lumbar
strength testing and strengthening based on progressive
protocols using specific equipment. Comparison of
results should clarify the effect of the treatment
center versus the efficacy of standardized protocols.
Summary of Background Data. There has been
little support in the scientific literature for exercise
programs based on standardized protocols. The use
of specialized equipment to achieve intense specific
exercise also has been poorly supported. Overall
health benefit has not often been related to specific
improvement in strength.
Methods. More than 400 individuals with chronic
back pain were evaluated at the initiation of treatment,
discharge, and 1 year after discharge. Measures of
efficacy were based on Short Form-36 scores, self-appraisal
of improvement, and reuse of health care services
after discharge. Study participants were patients
with chronic back pain consecutively referred to
each treatment site and underwritten by a variety
of payers, including workers' compensation, Medicare,
and private insurance.
Results. Overall response during the course
of the program and at 1-year follow-up was similar
between the two centers. Similar proportions of participants
at each site demonstrated improvement in SF-36 scores,
self-appraisal of improvement, and reuse of health
care services.
Conclusions. Standardized protocols using
specific strength and measurement equipment can achieve
similar benefits at different sites. [Key words:
low back pain, outcomes, restorative exercise, strengthening,
treatment]
From U.S. Orthopedics, Little Rock, Arkansas; The Department of Orthopedics,
University of California, San Diego; Washington University, St. Louis, Mo.;
the Physicians Neck and Back Clinic, Minneapolis, MN, Preventive Care, Columbia,
Mo.
