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Ten-year follow-up of strengthening versus flexibility exercises with or without abdominal bracing in recurrent low back pain [with consumer summary]
Aleksiev AR
Spine 2014 Jun 1;39(13):997-1003
clinical trial
4/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

STUDY DESIGN: Randomized prevention trial. OBJECTIVE: To compare the long-term effect of strengthening versus flexibility exercises and to evaluate the additional effect of abdominal bracing in recurrent low back pain. SUMMARY OF BACKGROUND DATA: No conclusions could be made regarding appropriate exercise types or parameters in recurrent low back pain. Abdominal bracing increases trunk stiffness; however, its long-term effect has not been evaluated in recurrent low back pain yet. METHODS: Six hundred patients with recurrent low back pain participated. They were randomized into four groups -- 150 patients (age 42.5 +/- 12.7) performed strengthening exercises; 150 patients (age 41.3 +/- 11.5) performed flexibility exercises; 150 patients (age 41.0 +/- 13.2) performed strengthening exercises and used abdominal bracing in daily activities/exercises; and 150 patients (age 40.6 +/- 12.3) performed flexibility exercises and used abdominal bracing in daily activities/exercises. At the beginning of the study and at the end of ten consecutive years were recorded six outcomes -- frequency, intensity and duration of pain, as well as frequency, intensity and duration of exercises. RESULTS: Regarding the first four outcomes -- all groups showed improvement from the beginning to the second year, but worsening from the second to the tenth year; there was no difference between strengthening and flexibility groups; bracing groups showed better results versus non-bracing groups. Intensity, frequency and duration of the pain correlated with each other and with frequency of the exercises, but not with exercise duration or intensity. CONCLUSIONS: The exercise frequency is more important than the type, duration or intensity of the exercise. Abdominal bracing adds to the exercise effect. It could be considered as a "preliminary muscle back belt on demand" increasing the trunk stiffness and the frequency of the trunk muscle contractions/cocontractions without interruption of daily activities, which may remind/convince the patients to exercise more frequently. Frequent exercising and bracing appears effective long-term prevention advices in recurrent LBP.
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