Effectiveness of the Godelieve Denys-Struyf (GDS) Method in People With Low Back Pain: Cluster Randomized Controlled Trial
Authors: Díaz-Arribas María José , Kovacs Francisco M. , Royuela Ana , Fernández-Serrano Mónica , Gutiérrez-Fernández Lorena , San Martín-Pariente Oscar , Abraira Víctor , Ramos-Sánchez Mabel , Llorca-Palomera Rosa , Pardo-Hervás Pedro , Gestoso Mario , Sánchez-Gil Gracia Camacho , Elena-Lucas María Ángeles , Paniagua-de-la-Calle Raquel , Castellanos-López Isabel , García-Heredia María Ángeles , Cerón-Sanz Ana Miriam , Victoria-González Basilio , Monsalve-Martín Carmen , Duque-Heras José María , Juanes-Hernández Manuel J. , Saura-Contí Jana , Soto-Sáez Juan Luis , Román-Moraleda Carlos , Ruiz-Arias César , Martín-Mora Beatriz , Escolano-García Rubén , Cantero-Bengoechea José Sebastian , García-López Elena , López-Pelegrín Alicia , Padilla-Martin Elena , Martínez-Rodríguez María , Casillas-Martín Joaquín , Jerez-Vázquez Javier , Barrientos-Gómez Lucía 
Published: October 2014

Background
The Godelieve Denys-Struyf method (GDS) is a motor learning intervention that may be applied in group or individualized sessions.

Objective
The study objective was to compare the effectiveness of routine physical therapy, group GDS (GDS-G) sessions, and group and individualized GDS (GDS-I) sessions.

Design
This was a cluster randomized controlled trial.

Setting
The study took place in 21 primary care physical therapy units (“clusters”) of the Spanish National Health Service (SNHS).

Participants
The participants were 461 people with subacute and chronic low back pain (LBP).

Intervention
Clusters were randomized into 3 groups. All participants received medical treatment and a 15-minute group education session on active management. Additional interventions were as follows: control (fifteen 40-minute sessions of transcutaneous electrical nerve stimulation, microwave treatment, and standardized exercises), GDS-G (eleven 50-minute group GDS sessions), and GDS-I (the same 11 sessions plus four 50-minute individualized GDS sessions).

Measurements
Primary outcomes at baseline and 2, 6, and 12 months later were LBP and pain referred down the leg (separate pain intensity numeric rating scales) and disability (Roland-Morris Questionnaire [RMQ]). Secondary outcomes were use of medication and self-reported health (mental and physical component summaries of the 12-Item Short-Form Health Survey [SF-12]). Separate linear mixed models for LBP, pain referred down the leg, and disability were developed to adjust for potential confounders. Randomization, outcome assessment, and data analyses were masked.

Results
At 12 months, disability improved 0.7 (95% confidence interval [CI]=−0.4, 1.8) RMQ point in the control group, 1.5 (95% CI=0.4, 2.7) RMQ points in the GDS-I group, and 2.2 (95% CI=1.2, 3.2) RMQ points in the GDS-G group. There were no differences in pain.

Limitations
The amount of exercise was smaller in the control group, and GDS-I sessions were provided by junior physical therapists.

Conclusions
The improvement in disability was slightly higher with group GDS sessions than with the program routinely used in clusters within the SNHS. Adding individualized GDS sessions eliminated this advantage. Further studies should compare the GDS with other types of exercise.