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J Back Musculoskelet Rehabil. 2016 Nov 21;29(4):673-684.

Graded group exercise and fear avoidance behavior modification in the treatment of chronic low back pain.

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Physical Therapy Program, College of St. Scholastica, Duluth, MN, USA.
Sports Medicine, Essentia Health, Duluth, MN, USA.
Occupational Medicine, Essentia Health, Duluth, MN, USA.



Approaches in the treatment of general chronic low back pain (CLBP) are multifaceted relative to specific interventions. In the past, passive interventions have commonly been employed with little evidence to support their effectiveness. Recent reviews suggest a focus on active exercises programs that includes pain education and cognitive behavioral therapy.


To investigate the outcomes of CLBP patients and describe the approach in persons undergoing a group spinal rehabilitation program using graded exercise, and operant conditioning.


Adult patients with CLBP participated in a twice weekly 90 minute exercise sessions for 8-weeks (n= 201). The program consisted of behavioral education, stretching, aerobic exercises, graded progressive resistance exercise, MedX isotonic strengthening, and functional bending lifting task exercises.


A total of 201 patient records were evaluated where the overall ODI improvement was 13.2% (± 14.0) (p< 0.001). There were significant and clinically meaningful improvements in flexibility, VAS, functional lifting tasks (p< 0.001), and lumbar extension strength (p= 0.01) at 8-week follow-up. Questionnaires were delivered via mail with a 21% return rate revealed sustained improvements.


CLBP patients undergoing an 8-week intensive exercise approach incorporating both behavioral and physical conditioning principles showed both significant and clinically significant improvements in this observational case series. Long-term benefits were also seen in both the 6 and 12 month follow-up questionnaires although further investigation is warranted due to limited survey return rate and study design.


Kinesiophobia; Oswestry; chronic low back pain; graded exercise; group therapy; operant conditioning; rehabilitation

[Indexed for MEDLINE]

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