Comparing Pain Neuroscience Education Followed by Motor Control Exercises With Group-Based Exercises for Chronic Low Back Pain: A Randomized Controlled Trial.

Abstract

Different individualized interventions have been used to improve chronic low back pain (CLBP). However, their superiority over group-based interventions has yet to be elucidated. We compared an individualized treatment involving pain neuroscience education (PNE) plus motor control exercise (MCE) with group-based exercise (GE) in patients with CLBP. Seventy-three patients with CLBP were randomly assigned into the PNE plus MCE group (n=37) and GE group (n=36). Both PNE plus MCE and GE were administered twice weekly for 8weeks. Pain intensity (as measured using the VAS), disability (as measured using the Roland-Morris Disability Questionnaire), fear-avoidance beliefs (as measured using the Fear-Avoidance Beliefs Questionnaire), and self-efficacy (as measured using the Pain Self-Efficacy Questionnaire) were assessed at baseline and 8weeks post-intervention. A 2×2 variance analysis (treatment group×time) with a mixed-model design was applied to statistically analyze the data. Both groups showed significant improvements in all the outcome measures, with a large effect size (P<0.001, partial eta squared [ηp2 ]=0.66 to 0.81) after the intervention. The PNE plus MCE group showed greater improvements, with a moderate effect size in pain intensity (P=0.041, ηp2 =0.06) and disability (P=0.021, ηp2 =0.07) compared to the GE group. No significant difference was found in fear-avoidance beliefs during physical activity and work, and self-efficacy (P>0.05) between the 2 groups. PNE and MCE seem to be better at reducing pain intensity and disability compared to GE, while no significant differences were observed for fear-avoidance beliefs and self-efficacy between the 2 groups in patients with CLBP. With regard to the superiority of individualized interventions over group-based ones, more studies are warranted.