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ZusammenfassungLaut Studien liegt die Adhärenz von Patienten für Eigenübungen unter 50 Prozent. Als Therapeuten müssen wir diesem ernüchternden Ergebnis aber nicht hilflos gegenüberstehen. In Interviews geben Patienten klare Hinweise darauf, was sie in der Therapie benötigen, um auf lange Sicht die Übungen auszuführen. Wir sollten auf sie hören.

Background: Adherence to an exercise programme impacts the outcome of physiotherapy treatment in patients with non-specific low back pain.Objectives: The aim of this study was to explore the patients' perspectives on long term adherence to such exercise programmes.Design: This qualitative study was embedded in a randomised controlled trial (RCT) which compared the effectiveness of two types of exercise programme on patients with nonspecific low back pain.Methods: Answers from 44 participants to three open-ended questions were analysed using thematic analysis.Results/findings: Patients' perceptions related to the following themes: 1) the role of knowledge in long-term exercise adherence; 2) strategies to support exercise adherence; 3) barriers to exercise adherence 4) the role of perceived effects of exercise.Conclusions: Adherence to long-term exercise is supported through knowledge of the exercises and correct performance. A self-initiated training strategy is the most successful in the perception of participants. Individually supervised physiotherapy treatment that includes coaching towards strategies for post-treatment long term exercise behaviour is recommended.

Background: Exercise is an effective treatment for patients with sub-acute and chronic non-specific low back pain (NSLBP). Previous studies have shown that a subgroup of patients with NSLBP and movement control impairment (MCI) can be diagnosed with substantial reliability. However, which type of exercises are most beneficial to this subgroup is still unknown.Objectives: The effectiveness of a specific exercise treatment to improve movement control was tested in this study.Methods: Using a multicentre randomised controlled trial (RCT), we compared exercises that targeted MCI (MC) with a general exercise (GE) treatment. After randomisation, patients in both groups n(MC = 52; GE = 54) were treated in eight private physiotherapy practices and five hospital outpatient physiotherapy centres. Follow-up measurements were taken at post-treatment, six months and 12 months. The primary outcome measurement was the Patient Specific Function Scale (PSFS).Results: PSFS showed no difference between groups after treatment, or at six months and 12 months. Secondary outcome analysis for pain and disability, measured with the Graded Chronic Pain scale and the Roland Morris Disability Questionnaire respectively, showed that a small improvement post-treatment levelled off over the long term. Both groups improved significantly (p Conclusion: This study found no additional benefit of specific exercises targeting MCI. (C) 2015 Elsevier Ltd. All rights reserved.

The project was supported by the Swiss National Science Foundation (SNSF, Project no. 127240)., Background: Exercise is an effective treatment for patients with sub-acute and chronic low back pain (LBP). Patients with a movement control impairment (MCI) can be diagnosed as a subgroup of patients with LBP. Unknown is which exercise intervention is most beneficial for this subgroup. This study assessed the short-term effect of a specific exercise program targeting movement control impairment versus general exercise treatment on disability in patients with LBP and MCI. Methods: In a multicentre parallel group randomised controlled pragmatic trial, patients with sub-acute and chronic LBP were included. Further inclusion criteria were disability of ≥5 points on the Roland-Morris Disability Questionnaire and ≥2 positive tests out of a set of 6 movement control impairment tests. A total of 106 patients were randomly assigned to either tailored movement control exercise intervention (MC, n=52) or a general exercise intervention (GE, n=54); both 9-18 individual treatment sessions, over a maximum of 12 weeks. . The primary outcome was disability measured with the Patient Specific Functional scale (PSFS). Secondary outcome was the Roland-Morris disability scale (RMDQ). Measurements were taken pre- and posttreatment. Results: No significant difference was found following the treatment period. Baselineadjusted between-group mean difference for the PSFS was 0.5 (SD = 0.5; p = 0.32) in favour of MC exercises. The Roland-Morris Disability Questionnaire revealed a significant, but not clinically relevant, between-group difference of 2.0 points (SD = 0.8; p= 0.01). Conclusion: Disability in LBP patients was reduced considerably by both interventions. However, the limited contrast between the two exercise programs may have influenced outcomes.

Purpose: To assess the optimal cut-off for of a summary score of six movement control impairments tests. Methods: Subjects were 1180 patients with back pain and 102 healthy subjects without back pain. Design:A cross sectional study with cases and controls to find out the best cut off point score or the best test combination for discriminative validity between patients with back pain and healthy controls. Statistical analyses: Diagnostic odds ratios, sensitivity and specificity for the different cutoffs as well as area under the curve values were calculated with logistic regressions with corresponding 95% confidence intervals. Results: The optimal cut-off was with two or more positive movement control impairment tests out of six, resulting in a diagnostic odds ratio of 8.04 (95%CI 4.30 to 15.06 and a sensitivity of 68% and a specificity of 79%. If analysed individually, the test with the best discriminative validity was the prone knee bend (AUC0.67; OR 5.58, sensitivity 51%, specificity 84%), followed by four point kneeling (AUC 0.65, OR 3.7, sensitivity 52%, specificity 77%; and waiters bow (AUC 0.62, OR 4.6, sensitivity 33% and specificity 90%). Conclusion(s): The optimal cut-off for discriminating patients with back pain from healthy controls was with two or more positive movement control impairment tests out of six, resulting in a diagnostic odds ratio of 8.04. Implications: It is recommendable to use the whole test battery of six tests tpoevaluate the movement control ability of the subjects. If two or more tests are positive, the Odds are 6 to 1 that this person has back pain.

«Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch)», Schmerzen des untere Rückens sind meist unspezifisch, d. h. es gibt keinen spezifischen medizinischen Grund für die Schmerzen. Eine Subgruppierung unspezifischer Rückenschmerzen wurde deswegen als einer der wichtigsten Forschungsschwerpunkte genannt. Eine mögliche Subgruppe ist die Bewegungskontrolldysfunktion, bei der der Patient seine Bewegungen nicht bewusst kontrollieren kann. Eine Testbatterie wurde entwickelt und validiert, um diese Patientengruppe zu untersuchen und zu behandeln. Sie besteht aus 6 Bewegungstests und wurde als reliabel bewertet. Mit diesem Testverfahren können Personen mit Rückenschmerzen zuverlässig von gesunden Personen unterschieden werden. Ebenfalls untersucht wurde der Zusammenhang mit der Körperwahrnehmung. Dabei zeigte sich, dass Zweipunktdiskriminationsfähigkeit mit der verschlechterten Bewegungskontrolle des Rückens korreliert. Eine Fallserienstudie (n=38) ergab, dass diesen Patienten mit spezifischen Übungen gut geholfen werden kann. Da es in dieser Studie keine Kontrollgruppe gab, kann jedoch eine Kausalität nicht hergestellt werden. Low back pain (LBP) is in most cases non-specific, meaning that there is no clear medical cause for the problem. Subgrouping of these patients has been declared as one of main research areas of LBP. One possible subgroup of LBP is movement control dysfunction which means that patients cannot actively control movements of the lower back. A test battery consisting of six movement control tests was created to examine this dysfunction and was found to be reliable. The test battery can discriminate between patients with LBP and healthy controls. It was also shown that patients with movement control deficits have a distorted body image which can be measured with two-point discrimination tests. In a case series study (n = 38) patients with movement control dysfunction could be extensively improved in their disability, pain and function. However, as there was no control group in the study no causal conclusions can be drawn.

Background Non-specific low back pain (NSLBP) in subacute and chronic stages can be treated effectively with exercise therapy. Research guidelines recommend evaluating different treatments in defined subgroups of patients with NSLBP. A subgroup of patients with movement control impairment (MCI) improved significantly on patient specific function and disability in a previous case series after movement control exercises. Methods/Design In a randomised controlled trial (RCT) we will compare the effectiveness of movement control and general exercise in patients with MCI. 106 participants aged 18 - 75 will be recruited in 5 outpatient hospital departments and 7 private practices. Patients randomly assigned to the movement control exercise group will be instructed to perform exercises according to their MCI. The general exercise group will follow an exercise protocol aimed at improving endurance and flexibility. Patients in both groups will receive 9 - 18 treatments and will be instructed to do additional exercises at home. The primary outcome is the level of disability assessed using the patient specific functional scale (PSFS) which links the perceived pain to functional situations and is measured before treatment and at 6 and 12 months follow-up. Secondary outcomes concern low back pain related disability (Roland Morris questionnaire, RMQ), graded chronic pain scale (GCPS), range of motion and tactile acuity. Discussion To our knowledge this study will be the first to compare two exercise programs for a specific subgroup of patients with NSLBP and MCI. Results of this study will provide insight into the effectiveness of movement control exercise and contribute to our understanding of the mechanisms behind MCI and its relation to NSLBP. Trial registration Current Controlled Trials ISRCTN80064281