Positive Health Online
Your Country
![[Image: http://www.abundanceandhealth.co.uk]](/img/original/BannerAvatar/2836.df7d2315253110ff5b3a566f94871f99.jpg "http://www.abundanceandhealth.co.uk")
![[Image: https://www.water-for-health.co.uk/]](/img/original/BannerAvatar/4046.12831f50177f8848ee87b8e94411d6b3.jpg "https://www.water-for-health.co.uk/")
![[Image: http://www.balens.co.uk]](/img/original/BannerAvatar/2148.50367fa908013fae0a7f1a171543ef92.jpg "http://www.balens.co.uk")
![[Image: http://www.drsgoodman.com/books-goodman/52-nutrition-and-cancer]](/img/original/BannerAvatar/1859.1296090fd8385e7ceff51c8011559097.jpg "http://www.drsgoodman.com/books-goodman/52-nutrition-and-cancer")
Research: EWERT and COLLEAGUES,
Listed in Issue 170
Abstract
EWERT and COLLEAGUES, Department of Physical Medicine and Rehabilitation, Ludwig-Maximilian University, Munich, Germany compared a multimodal prevention program and a general physical exercise program in the development of chronic low back pain in nurses.
Background
The objective of this study was to examine whether a multimodal, secondary prevention program (MP) is superior to a general physical exercise program (EP) in influencing the process leading to chronic low back pain (LBP) in nurses with a history of back pain.
Methodology
The study was conducted as a randomized controlled parallel-group trial.The interventions were performed in a single center at the Department of Physical and Rehabilitation Medicine at the University of Munich in Germany. A total of 235 nurses from 14 nearby hospitals and nursing homes who experienced at least one episode of back pain during the previous 2 years were invited into the study. Of these, 183 nurses were enrolled and 169 (83 in the MP and 86 in the EP) qualified for the intent-to-treat analysis. The EP consisted of 11 group sessions, each lasting 1 hour. After introductory sessions, subsequent sessions included general physical strengthening and stretching exercises as well as instructions for a home-training program. The MP consisted of 17 group sessions of 1.75 hours and one individual session of 45 minutes. In addition to the full EP, the MP included 5 psychological units, 7 segmental stabilization exercises units, and 8 ergonomic and workplace-specific units. Main Outcome Measurements: The primary study end-point variable was pain interference, and the secondary study end-point variables were pain intensity and functioning as measured with the West Haven-Yale Multidimensional Pain Inventory and the Short Form-36, respectively. These study end-point variables were defined a priori.
Results
There was no statistically significant difference between the 2 groups. Small-to-moderate effects were observed in both intervention programs across all study end-point variables. For pain interference, the effect size at 12 months after intervention was 0.58 in the MP and 0.47 in the EP.
Conclusion
A multimodal program is not superior to a general exercise program in influencing the process leading to chronic LBP in a population of nurses with a history of pain. The most likely explanation is a common psychological mechanism leading to improved pain interference that is irrespective of the program used. Considering the lower resources of the general exercise program, the expense for a multimodal program is not justified for the secondary prevention of LBP and disability.
References
Ewert T, Limm H, Wessels T, Rackwitz B, von Garnier K, Freumuth R and Stucki G. The comparative effectiveness of a multimodal program versus exercise alone for the secondary prevention of chronic low back pain and disability. Pm & R. 1 (9): 798-808. Sep 2009.
