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Motor control exercises, sling exercises, and general exercises for patients with chronic low back pain: a randomized controlled trial with 1-year follow-up [with consumer summary]
Unsgaard-Tondel M, Fladmark AM, Salvesen O, Vasseljen O
Physical Therapy 2010 Oct;90(10):1426-1440
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; 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: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Exercise benefits patients with chronic nonspecific low back pain; however, the most effective type of exercise remains unknown. OBJECTIVE: This study compared outcomes after motor control exercises, sling exercises, and general exercises for low back pain. DESIGN: This was a randomized controlled trial with 1-year follow-up. SETTING: The study was conducted in a primary care setting in Norway. PATIENTS: The participants were patients with chronic nonspecific low back pain (n = 109). INTERVENTIONS: The interventions in this study were low-load motor control exercises, high-load sling exercises, or general exercises, all delivered by experienced physical therapists, once a week for 8 weeks. MEASUREMENTS: The primary outcome measure was pain reported on the numeric pain rating scale after treatment and at a 1-year follow-up. Secondary outcome measures were self-reported activity limitation (assessed with the Oswestry Disability Index), clinically examined function (assessed with the Fingertip-to-Floor Test), and fear-avoidance beliefs after intervention. RESULTS: The postintervention assessment showed no significant differences among groups with respect to pain (overall group difference) or any of the outcome measures. Mean (95% confidence interval) group differences for pain reduction after treatment and after 1 year were 0.3 (-0.7 to 1.3) and 0.4 (-0.7 to 1.4) for motor control exercises versus sling exercises, 0.7 (-0.6 to 2.0) and 0.3 (-0.8 to 1.4) for sling exercises versus general exercises, and 1.0 (-0.1 to 2.0) and 0.7 (-0.3 to 1.7) for motor control exercises versus general exercises. Limitations The nature of the interventions made blinding impossible. CONCLUSIONS: This study gave no evidence that 8 treatments with individually instructed motor control exercises or sling exercises were superior to general exercises for chronic low back pain.

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