• Paul Marshall and Bernadette Murphy.
• Department of Sport and Exercise Science, University of Auckland, Auckland, New Zealand. p.marshall@auckland.ac.nz
• Spine. 2008 Feb 1;33(3):326-38.

Study DesignSixteen-week intervention for chronic patients with low back pain (LBP) with 9-month follow-up. Primary randomization at 4 weeks into either supervised Swiss ball exercise or an exercise advice group.ObjectiveTo evaluate changes in disability and pain in individuals with chronic LBP after combined treatment and exercise interventions, and to evaluate whether changes in self-report or physical measures would best explain improvements in disabilitySummary Of Background DataThere is a need to understand what the effectiveness of a clinically applicable treatment intervention is for an individual's perception of their back pain. There is insufficient evidence about the different combinations of manual treatment that commonly precede involvement in exercise programs.MethodsSixty individuals with chronic nonspecific LBP (at least 3-month duration) were randomly assigned (after 4 weeks of manipulative or nonmanipulative treatment) to either a supervised Swiss ball exercise group, or an advice group. The exercise intervention was for 12 weeks with a long-term follow-up of 9 months. Self-report measures and physical measures (endurance times and myoelectric fatigue) were collected throughout the study.ResultsSelf-rated disability improved more after the treatment period for individuals who received supervised exercise compared with advice alone. There was no difference found between individuals who received manipulative or nonmanipulative treatment. Multiple regression analysis found that self-report measures best explained improvements in disability throughout the study. Long-term findings showed no group differences.ConclusionSupervised exercise is a more successful subsequent to manual treatment compared with exercise advice. The improvements associated with this type of program were primarily manifested in the psychologic self-report measures rather than physical measurements.

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