Aquatic exercise and pain neurophysiology education versus aquatic exercise alone for patients with chronic low back pain: a randomized controlled trial

• Published in: Clinical rehabilitation Vol. 29; no. 6; pp. 538 - 547
• Main Authors: Pires, Diogo, Cruz, Eduardo Brazete, Caeiro, Carmen
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.06.2015; Sage Publications Ltd
• Subjects: Back pain; Chronic Pain - therapy; Clinical trials; Education; Exercise Therapy - methods; Female; Humans; Intervention; Low Back Pain - therapy; Male; Middle Aged; Nervous System Physiological Phenomena; Neurophysiology; Outpatient care facilities; Pain Management - methods; Performance evaluation; Physical therapy; Single-Blind Method; Water; Portugal; chronic low back pain; exercise; pain; Education; disability
• ISSN: 0269-2155; 1477-0873; 1477-0873
• DOI: 10.1177/0269215514549033

Objective: The aim of this study was to compare the effectiveness of a combination of aquatic exercise and pain neurophysiology education with aquatic exercise alone in chronic low back pain patients. Design: Single-blind randomized controlled trial. Setting: Outpatient clinic. Subjects: Sixty-two chronic low back pain patients were randomly allocated to receive aquatic exercise and pain neurophysiology education (n = 30) or aquatic exercise alone (n = 32). Interventions: Twelve sessions of a 6-week aquatic exercise programme preceded by 2 sessions of pain neurophysiology education. Controls received only 12 sessions of the 6-week aquatic exercise programme. Main measures: The primary outcomes were pain intensity (Visual Analogue Scale) and functional disability (Quebec Back Pain Disability Scale) at the baseline, 6 weeks after the beginning of the aquatic exercise programme and at the 3 months follow-up. Secondary outcome was kinesiophobia (Tampa Scale of Kinesiophobia). Results: Fifty-five participants completed the study. Analysis using mixed-model ANOVA revealed a significant treatment condition interaction on pain intensity at the 3 months follow-up, favoring the education group (mean SD change: −25.4± 26.7 vs −6.6 ± 30.7, P < 0.005). Although participants in the education group were more likely to report perceived functional benefits from treatment at 3 months follow-up (RR=1.63, 95%CI: 1.01–2.63), no significant differences were found in functional disability and kinesiophobia between groups at any time. Conclusions: This study’s findings support the provision of pain neurophysiology education as a clinically effective addition to aquatic exercise.