Behavioural medical rehabilitation (BMR), used in Germany, can be employed in treating of chronic low back pain (CLBP). A central component of BMR is standard exercise therapy (SET), which has the main direction of improving physical fitness. There is a need to address psychosocial factors within SET and therefore to improve behavior change with a focus on the development of self-management skills in dealing with CLBP. Furthermore, short-term effectiveness of BMR with a SET has been proven, but the impact of a behavioural exercise therapy (BET) for improvement of the long-term effectiveness of BMR is not clear.
To compare the effectiveness of two exercise programs that don’t use the same aproach within BMR on the effects of BMR a prospective randomised controlled trial (RCT) in two rehabilitation centres will be performed including 214 patients aged 18 – 65 with CLBP. Both exercise programs have a mean duration of 26 hours in three weeks and are delivered by a limited number of not-blinded study therapists in closed groups with six to twelve patients who will be masked regarding study group. The main differences of BET lie in its detailed manualised program with a theory-based, goal-orientated combination of exercise, education and behavioural elements, active participation of patients and consideration of their individual preferences and previous experiences with exercise. The primary outcome is functional ability assessed with the Hannover Functional Ability Questionnaire directly before and after the rehabilitation program, as well as a six and twelve-month follow-up.
This RCT is designed to investigate the effects of BET on the effectiveness of a BMR compared to a BMR with SET in the management of patients with CLBP. Methodological challenges arise from conducting a RCT within routine health care as well as from guaranteeing high treatment integrity. Findings of this study might add to a better understanding of the mechanism of action of BMR and the special effects of BET and may be used to improve the quality of these interventions in routine care, therefore lowering the burden to patients with disabling CLBP.
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