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 versus -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 to 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.

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