Chronic Low Back Pain
Conditions
Brief summary
Multidisciplinary behavioral-orthopedic rehabilitation in the treatment of chronic back pain has proven its short-term effectiveness. Exercise therapy plays a major role in such a combination of treatments. There is a considerable need to develop theory-based exercise interventions which foster a long-term adherence to physical activity. Furthermore, an integration of behavioral elements such as coping competencies regarding back pain is needed. It is not yet clear, which specific part of multidisciplinary rehabilitation causes its effects. The role of exercise therapy has yet to be investigated. Aim of this study is the implementation of a standardized behavioral exercise therapy into an existing behavioral-medical rehabilitation for patients with chronic back pain. The main hypothesis is that the participation in the behavioral exercise therapy leads to greater short- and long-term improvements in functional capacity compared to the usual care.
Interventions
BEHAVIORALBehavioral Medical Rehabilitation plus behavioral exercise therapy
The Intervention Group is characterized by the same treatment as in the control group, plus a modification of the exercise therapy. An Behavioral Exercise Therapy (BET) is implemented in the usual care. The Behavioral Exercise Therapy is based on a goal-oriented and systematic combination of knowledge-, behavior-, and exercise-related elements. It had been developed prior as part of a multidisciplinary treatment and was adapted for this study. The Aims of BET are gradual improvements of individual coping competencies and self-management regarding back pain as well as long-term adherence to physical activity.
BEHAVIORALUsual Behavioral Medical Rehabilitation
The Behavioral Medical Rehabilitation (BMR), which is in this case the control group (usual care), consists of usual orthopedic medical care, exercise therapy, individual physiotherapy, psychological treatment elements (e.g. a pain management group), occupational therapy and back school. Pain medication is given if necessary. For the most part, the psychological elements draw a distinction between more traditional concepts or orthopedic rehabilitation and the BMR. The pain management group with its cognitive-behavioral principles comprises 9 sessions of 90 minutes each.
Sponsors
Deutsche Rentenversicherung
University of Erlangen-Nürnberg
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
(ICD-10): * F45.4 Persistent somatoform pain disorder * F45.41 Chronic pain disorder with somatic and psychological factors * F54 Psychological and behavioural factors associated with disorders or diseases classified elsewhere * M51.2 Other specified intervertebral disc displacement * M51.3 Other specified intervertebral disc degeneration * M51.4 Schmorl's nodes * M51.8 Other specified intervertebral disc disorders * M51.9 Intervertebral disc disorder, unspecified * M53.8 Other specified dorsopathies * M53.9 dorsophathy, unspecified * M54.4 Lumbago with sciatica * M54.5 Low back pain * M54.6 Pain in thoracic spine * M54.8 Other dorsalgia * M54.9 Dorsalgia, unspecified * R52.2 Other chronic pain
Exclusion criteria
* distinct specific diagnosis for back pain (e.g. radicular symptoms, myelopathy) * severely limited health status (comorbidity) * serious impairment of vision and hearing (not corrected) * serious psychiatric codiagnosis (exkl. see inclusion criteria) * inability to speak german * pension claim (§51 SGB V - german law)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hannover Functional Ability Questionnaire (HFAQ) (Kohlmann, Raspe, 1996) | one year | The Hannover Functional Ability Questionnaire surveys the subjective estimate of a person of his or her functional ability in the context of physical activities of daily living. The Questionnaire has 12 Items. The participant is asked whether he or she is able to perform activities (e.g. to put on and pull off one's socks) and rates each on a 3-point scale (1=yes, 2=yes, but with trouble), 3=no, or only with help). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Numeric Rating Scale (NRS) to assess pain intensity (Farrar et al., 2001) | one year | Three items to assess the pain intensity felt by participants at the moment, as well as during the last six months (mean and maximum pain). |
| Graded Chronic Pain Status (GCPS)(von Korff et al., 1992)(adapted for 6 months) | one year | Six items to assess the number of days with pain during the last six months, the history of pain and the functional disability due to pain. |
| Generalized Anxiety Disorder (GAD-7) (Löwe et al., 2008) | one year | — |
| HAPA variables (Fleig et al., 2011; Sniehotta et al., 2005; Schwarzer et al., 2011) | one year | The HAPA variables include a stage assessment of behaviour change: Have you performed moderate physical for 30 minutes or longer on a minimum of 3 days per week? (rating: No, and I don't intend to do so - No, but I am currently thinking about that - No, but I strongly intend to do so - Yes, but it is difficult to me - Yes and it is easy to me) Further more, the HAPA variables include a validation item (Since when are you regularly active as you are now?) and sets of items about the participants' intention, self-efficacy, action and coping planning, risk perception, expectations of consequences of physical activity behaviour and action control regarding physical activity. See Schwarzer et al., 2011 (Rehabilitation psychology 56(3), 161-170) for more details. Furthermore, experiences with physical activity are included (Fleig et al., 2011). |
| Health-related Quality of Life (SF-12) (Bullinger, Kirchberger, 1998) | one year | — |
| Freiburger Questionnaire on Physical Activity (FQPA) (Frey et al., 1999) | one year | The FQPA measures the amount of physical activity in different contexts performed by the participants: occupational setting (rating: intensive movement, moderate movement, mostly sitting) as well as leisure time physical activity (e.g. gardening, stair-climbing, habitual walking and cycling, sports). It consists of eight items. |
| Perceived Stress scale (Cohen, Williamson, 1988) | one year | — |
| Attitudes towards performing sports (Brand, 2006) | one year | Four items assess the attitudes towards performing physical activity which are based on cognitions (e.g. When I think about it, I regard physical activity as: not healthy -- very healthy). Four items assess the attitudes based on affective judgement (e.g. When I think about bein physically active, I feel not satisfied -- very satisfied). Each of the eight items is rated on a 7-point scale in between the two poles. |
| Questionnaire for the detection of pain coping strategies (FESV) (Geissner, 2001) | one year | — |
| Tampa Scale of Kinesiophobia (TSK) (Kori et al., 1990) | one year | — |
| Avoidance-Endurance Questionnaire (AEQ) (Hasenbring et al., 2009) | one year | — |
| Depression (PHQ-D) (Löwe et al., 2002) | one year | — |
Countries
Germany
Outcome results
None listed