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Low-dose, non-supervised, health insurance initiated exercise for the treatment and prevention of chronic low back pain in employees. Results from a randomized controlled trial
Haufe S, Wiechmann K, Stein L, Kuck M, Smith A, Meineke S, Zirkelbach Y, Rodriguez Duarte S, Drupp M, Tegtbur U
PLoS ONE 2017 Jun;12(6):e0178585
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; 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*

OBJECTIVE: Back pain is a major problem requiring pragmatic interventions, low in costs for health care providers and feasible for individuals to perform. Our objective was to test the effectiveness of a low-dose 5-month exercise intervention with small personnel investment on low back strength and self-perceived pain. METHODS: Two hundred twenty-six employees (age 42.7 +/- 10.2 years) from three mid-size companies were randomized to 5-month non-supervised training at home (3 times/week for 20 minutes) or wait-list-control. Health insurance professionals instructed the participants on trunk exercises at the start and then supervised participants once a month. RESULTS: Muscle strength for back extension increased after the 5-month intervention with a significant between-group difference (mean 27.4 Newton (95%CI 2.2 to 60.3)) favoring the exercise group (p = 0.035). Low back pain was reduced more in subjects after exercise than control (mean difference -0.74 cm (95%CI -1.17 to -0.27), p = 0.002). No between-group differences were observed for back pain related disability and work ability. After stratified analysis only subjects with preexisting chronic low back pain showed a between-group difference (exercise versus controls) after the intervention in their strength for back extension (mean 55.7 Newton (95%CI 2.8 to 108.5), p = 0.039), self-perceived pain (mean -1.42 cm (95%CI -2.32 to -0.51), p = 0.003) and work ability (mean 2.1 points (95%CI 0.2 to 4.0), p = 0.032). Significant between-group differences were not observed in subjects without low back pain: strength for back extension (mean 23.4 Newton (95%CI -11.2 to 58.1), p = 0.184), self-perceived pain (mean -0.48 cm (95%CI -0.99 to 0.04), p = 0.067) and work ability (mean -0.1 points (95%CI -0.9 to 0.9), p = 0.999). An interaction between low back pain subgroups and the study intervention (exercise versus control) was exclusively observed for the work ability index (p = 0.016). CONCLUSION: In middle-aged employees a low-dose, non-supervised exercise program implemented over 20 weeks improved trunk muscle strength and low back pain, and in those with preexisting chronic low back pain improved work ability.

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