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WHICH PATIENTS BENEFIT MOST FROM AN EXERCISE PROGRAMME FOR BACK PAIN PATIENTS?



Abstract

Background and Purpose: The purpose of this study was to find out if a sub group of patients might particularly benefit from a structured programme of exercise classes. Such a programme originally designed for chronic back patients, has been further developed for use in the community, and has been shown to have a small but significant effect in reducing disability1. Recent evidence points to the potentially important role of fear, distress and depression in predicting outcome.

Method and results: A subgroup analysis was carried out on patient outcomes from a randomised controlled trial comparing a ‘Back to Fitness’ programme of exercise classes with usual GP care, in order to test whether patients with high scores on measures of fear-avoidance and distress/depression benefit the most. Data from 179 back pain patients were analysed after categorising baseline scores on fear-avoidance beliefs (high/low) and distress/depression (at risk/normal). The main outcome measure was the Roland Disability Questionnaire. Outcomes were compared between the intervention and control groups at 6 weeks, 6 months and 12 months.

High fear-avoiders fared significantly better in the exercise programme than in usual GP care at 6 weeks and at 1 year. Low fear-avoiders did not. Patients who were distressed or depressed were significantly better off at 6 weeks but the benefits were not maintained long-term.

Conclusion: Patients with high levels of fear-avoidance beliefs could significantly benefit from the Back to Fitness programme. In the clinical setting, it might be worth screening patients for high fear avoidance beliefs and making such a programme available to them.

Correspondence should be addressed to the editorial secretary: Dr Charles Pither, c/o British Orthopaedic Society, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN.

1 Klaber Moffett J, Torgerson D, Bell-Syer S, Jackson D, Llewelyn Phillips H, Farrin A, et al. A randomised trial of exercise for primary care back pain patients: Clinical outcomes, costs and preferences. British Medical Journal1999;319:279–283. Google Scholar