Therapy Exercises and Physiotherapy Delivered Operant Conditioning in the Treatment Chronic Low Back Pain
Condition: Chronic Nonspecific Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      This study investigates the effect of two physiotherapy models in the treatment of chronic
      nonspecific low back pain. Participants will be divided into three groups, two experimental
      and one control. In both experimental groups, the participants will be included in the
      intensive program of Therapy Exercises, under the supervision and guidance of the
      physiotherapist, and the group will differ in implemented behavioral therapy (which he will
      implement by a physiotherapist). In the control group, subjects will receive the usual
      treatment. The Back School will be applied in all groups.
    

Detailed description: 
      Low back pain is a global public health problem, one of the main causes of disability of the
      population, as well as enormous economic costs in the health system. This claim specifically
      relates to chronic low back pain. The clinical picture of chronic low back pain in addition
      to pain, muscle spasm, and functional disability dominate psychological problems, which
      significantly affect the outcome of treatment. The multidisciplinary approach to the
      treatment of chronic low back pain has proven to be the most effective, bad economically
      unacceptable, and unavailable in many countries. Therefore, it is necessary to find the most
      effective and economically most acceptable approach to the treatment of chronic low back
      pain.

      Physiotherapy is an unavoidable method of treating this painful condition, and changes in
      treatment approaches are most evident in this medical profession. Recently, physiotherapy
      includes two models in the treatment of chronic low back pain. A biomedical model consisting
      of well-known physiotherapy methods and a Biopsychosocial model that, in addition to known
      physiotherapy methods, includes a part of cognitive-behavioral therapy associated with motion
      and behavior, operative conditioning. Therapy exercise is an effective method indispensable
      part of both models of physiotherapy.

      The reason for changes in physiotherapy is a varied clinical picture of chronic low back
      pain. Evidence-based effectiveness of therapy exercise has been determined on reduction of
      the body's symptoms, pain, and functional disabilities. The effect of reducing psychological
      symptoms has been poorly investigated. Also, the use of therapeutic exercises in the practice
      creates several concerns related to the intensity of exercise, mode and time-frame of their
      application, and the type or method of exercise.

      Because it's already a known effect of operant conditioning through a multidisciplinary
      approach to reducing the psychological symptoms of chronic low back pain, it is suggested
      that this part of cognitive-behavioral therapy be implemented in physiotherapy, namely
      therapy exercise. Studies aimed to determine the effect of biopsychosocial physiotherapy
      models are scarce and insufficiently clear.

      The aims of this study are:

        1. Determine the effectiveness of a biomedical model of physiotherapy in the treatment of
           chronic nonspecific low back pain,

        2. Determine the effectiveness of the biopsychosocial model of physiotherapy in the
           treatment of chronic nonspecific low back pain, and

        3. Compare the effectiveness of these interventions.
    

Intervention name(s): Graded Activity; Group-based Therapy Exercise; Back School
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Active participation of participants, Overcoming and eliminating negative behaviors, Encouraging positive behavior in pain, Overcoming the fear of the movement, Motivation to implementation pre-set specific goals.; Aerobic exercise, Stretching exercise and flexibility, Range of motion, Balance and coordination, Breathing exercises Stabilization exercise Muscle strength training exercise; Basic information of Low Back Pain - anatomy, physiology, causes, treatment. Correct postures - standing, sitting, driving, sleeping, Correct body movements - lifting, pushing, walking.
Other intervention name(s): Physiotherapy - Provided Operant Conditioning; Exercises Therapy, Kinesitherapy
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: By randomization, the participants will be divided into three groups, two experimental groups, and a control group. In the first experimental group, the investigated interventions will consist of Therapy Exercise and Back School. In the second experimental group, in addition to the Therapy Exercise and the Back School, operative conditioning will be performed by the master of physiotherapy. The participants in the control group will be exposed to the usual treatment.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Low Back Pain; Nonspecific; Operant Conditioning; Graded Activity; Therapy Exercise