Physical Therapy (96)
Authors: Taimela Simo , Diederich Carlo , Hubsch Marc , Heinricy: Michel 
Published: September 2010

The role of physical exercise and inactivity in pain recurrence and absenteeism from work after active outpatient rehabilitation for recurrent or chronic low back pain: A follow‐up study. (DBC International, Vantaa, Finland) Spine 2000;25:1809–1816.

This study analyzed the role of physical exercise and inactivity on long‐term outcome after active outpatient low back rehabilitation. One hundred twenty‐five patients with low back pain, who had participated in a 12‐week active low back rehabilitation program, were asked about subjective pain and disability on the average of 14 months after the treatment. The outcomes were defined as a recurrence of persistent pain and work absenteeism, and a survival or failure analysis was performed between those who had continued exercising and who had been physically inactive. Recurrences of persistent pain during the follow‐up period were fewer (P = 0.03) among those who had maintained regular exercise habits after the treatment than among those who had been physically inactive. Similarly, work absenteeism was less (P < 0.01) among physically active than among physically inactive persons. However, patients with good outcome in pain reduction after low back pain rehabilitation were more likely to participate in physical exercise. Conclude that exercises are beneficial after guided treatment in the maintenance of the results of active treatment for recurrent chronic low back pain in the long term, but those with less favorable outcome in rehabilitation are less likely to participate in exercises afterward. In active treatment programs, it is recommended that exercises be incorporated after the guided treatment.

Comment by Phillip S. Sizer Jr., MEd, PT.

Historically, clinicians have instructed their patients to use trunk exercise to reduce the severity and duration of the symptoms and functional losses associated with low back pain (LBP). Through the years increasing evidence has supported this notion. However, fewer investigators have evaluated the impact of exercise after the rehabilitation process has been completed. This investigation performed this evaluation and found that regular, postrehabilitation exercise improved long‐term outcomes for patients who had previously suffered from LBP. Specifically, the investigators reported that ongoing exercise performed after an active outpatient rehabilitation program reduced recurrence of symptoms and absenteeism from work, especially after 1 year postonset. Additionally, these benefits did not appear to differ for those involved in self‐guided exercises versus those participating in a guided program with back‐specific devices in an outpatient treatment unit. This very interesting article reveals several pearls for the practitioner. First, subjects were not recruited on a voluntary basis, so to avoid attracting a group with good self‐motivation to alleviate their prevailing symptoms. This measure allows the outcomes to be applicable to a varied clinical population. Secondly, although the results favored the use of a guided program with back specific devices over self‐guided exercise, there were no statistical differences between the 2 approaches. Thus, patients can benefit from self‐monitored exercise even when they do not have access to a guided program using specific devices. Finally, the investigators revealed that poor clinical rehabilitation outcomes predicted postrehabilitation inactivity and reduced success with posttreatment exercise. Thus, the effectiveness of the rehabilitation process may influence patient's activity level and success of exercise after rehabilitation.