Individualised exercise rehabilitation for persistent low back pain

A 12-week individualised exercise rehabilitation program for persistent low back pain. The literature indicates that patients with persistent low back pain describe a preference for individualised exercise programs. In the first session (~1 hr) a registered physiotherapist will collaboratively develop physical activity goals with each participant. Based on these goals, an individualised exercise rehabilitation program will be developed with participants based on their preferences, symptoms, abilities and assessment findings. The aspects of the program to be individualised include: session frequency and duration and the aerobic, strengthening and specific muscle activation exercises. To inform the aerobic and strengthening exercises the physiotherapist will firstly determine each participant’s baseline exercise tolerance. Participants will be asked to rate their perceived exertion of their current exercise regime and describe how it affects their pain (if currently exercising). Based on this information and considering participants exercise goals, the physiotherapist will use a tool specifically designed for this intervention to determine whether to increase or decrease the duration, frequency or intensity of their exercise regime. Participant preferences regarding type of aerobic (e.g. walking, cycling) and strengthening (e.g. weight training, Barre) activities will also be incorporated. To inform the selection of specific muscle activation exercises, the physiotherapist will assess participant’s abdominal and back muscles using ultrasound imaging, pressure biofeedback and observation and palpation. Based on these assessment findings, the most appropriate exercises will be chosen based on the protocols of previous studies (e.g. Costa et al 2009). Participants will complete between two and seven 5–60-minute exercise sessions per week depending on their goals, abilities, symptoms and preferences. Exercise sessions will be conducted independently (i.e. not during physiotherapy appointments). Participants may use equipment if they have access to it and would like to use it. No equipment will be required or provided to participants. The exercise regime will be documented and provided to each participant to refer to. The physiotherapist will also educate on ways to help participants’ pain based on pain neuroscience education literature. This will cover content such as how the nervous system acts as an alarm system and the benefits of graded exercise. To monitor progress, participants will meet with the physiotherapist (~30 min appointments) once weekly during the first month, once fortnightly during the second month and on one occasion only in the final month. In these sessions, the exercise rehabilitation program will be reviewed and may be progressed/modified to meet participants individual needs and exercise goals. Exercise goals will be monitored using the Goal Attainment Light scale. Participants will be asked to rate the perceived exertion of their exercise sessions and the impact on their symptoms. The program may then be progressed or modified in these sessions by adjusting the duration, frequency and/or intensity of exercise sessions. Participants will be required to document completion of their exercise sessions in a provided booklet (designed specifically for this study) to monitor compliance with the regime during these appointments. The first several appointments will be conducted face to face and participants will have the option to transition to telehealth. Face-to-face appointments will be conducted at the University of South Australia.