Effectiveness of Non-Pain-Contingent Spine Rehabilitation in Females with Chronic Low Back Pain: A Randomized Controlled Trial

Abstract

Background: Evidence suggests that intensive rehabilitation programs (>100 hours) are effective in treating chronic low back pain (CLBP). However, less intensive, effective interventions are needed. Non-pain-contingent spine rehabilitation (NCSR) incorporating lifting training has been suggested, but its efficacy remains questionable. Objective: This study aimed to evaluate the effectiveness of NCSR, based on cognitive-behavioral therapy and lifting training, in decreasing pain and functional disability and in improving physical performance in females with CLBP. Methods: Fifty-four females with CLBP were randomized to receive either NCSR (n=28) or conventional physiotherapy (CPT) (n=26). Both groups received treatment twice a week for 6 weeks. Primary outcome measures were the visual analogue scale for pain and the Oswestry Disability Index. Secondary outcome measures included the range of motion for trunk flexion and extension, straight leg raising, Ito and Shirado tests, and progressive isoinertial lifting evaluation. Outcomes were assessed at baseline, week 4, and at discharge. Results: Both groups had a significant improvement in pain, functional disability measures, and all physical measures, but clinically relevant improvement was achieved only in the NSCR group. The NSCR group also showed a significantly greater improvement in trunk muscle endurance and lifting capacity scores. Conclusion: Patterns of improvement suggest that the NCSR approach is more effective than CPT in this subgroup of patients.