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Cognitive functional approach to manage low back pain in male adolescent rowers: a randomised controlled trial [with consumer summary]
Ng L, Caneiro JP, Campbell A, Smith A, Burnett A, O'Sullivan P
British Journal of Sports Medicine 2015 Sep;49(17):1125-1131
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; 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: Low back pain (LBP) is prevalent among adolescent rowers. This study evaluated the efficacy of a cognitive functional approach to reduce LBP in this population. METHODS: Thirty-six adolescent male rowers reporting LBP participated. Nineteen were randomly allocated to the intervention group to receive a cognitive functional approach targeting cognitions, movement patterns, conditioning and lifestyle factors relevant to each rower for 8 weeks. The active control group (n = 17) received usual care from their coaches (rowing skills and conditioning exercises). The primary outcome of the study was pain intensity as measured by the Numeric Pain Rating Scale during a 15 min ergometer trial preintervention and postintervention. Disability (Patient Specific Functional Scale and Roland Morris Disability Questionnaire) was measured preintervention/postintervention and at 12 weeks follow-up. Isometric muscle endurance of the back extensors and lower limb muscles, usual sitting posture and regional lumbar kinematic data during a 15 min ergometer row were measured preintervention/postintervention. RESULTS: Compared with the control group, the intervention group reported significantly less pain during ergometer rowing (numeric pain rating scale -2.4, p = 0.008) and reduced disability (Patient Specific Functional Scale (4.1, p = 0.01); Roland Morris Disability Questionnaire (-1.7, p = 0.003)) following the intervention, and at 12 weeks follow-up. They also demonstrated greater lower limb muscle endurance (20.9 s, p = 0.03) and postured their lower lumbar spine in greater extension during static sitting (-9.6 degrees, p = 0.007). No significant differences were reported in back muscle endurance and regional lumbar kinematics during ergometer rowing. CONCLUSION: Cognitive functional approach was more effective than usual care in reducing pain and disability in adolescent male rowers. CLINICAL TRIAL REGISTRY NUMBER: Australian and New Zealand Clinical Trial Registry number 12609000565246.
Reproduced with permission from the BMJ Publishing Group.

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