Three treatments a week has been practiced for years based on the assumption that maximum benefits will be attained and that a greater carryover of these benefits will occur once therapy has stopped as the repeated exercise program will be more engrained and habitual for the patient. This study challenges these notions. It was assumed by the authors that three times a week care was inconvenient and difficult for the patient to maintain over a prolonged basis, not to mention 33% more expensive. If twice a week treatments would accomplish the same goals without a loss of effectiveness, why not base the industry standard on that?
The study chose 77 consecutive patients and gave them the choice of 2 or 3 exercise-based sessions a week. All patients were middle-aged and employed. All had chronic lower back pain of an average duration of 32 months and all exhibited moderate degrees of both disability and impairment. Both therapy routines, whether twice weekly or thrice weekly, were structured the same; geared to lower back flexibility, strength and lifting capacity goals. All sessions were supervised in small groups for 2 hours per session, lasting a total of 6 weeks. In other words, one group chose 12 sessions and the other chose 18 sessions of physiotherapy. The subjects were assessed before beginning and 12 months after completing the programs.
What a surprise! There were no differences in any measured outcome after one year! Pain levels on all objective scales, low back function, and flexibility, lifting capacity, all identical! The costs and convenience to low back patients attending physiotherapy clinics for exercise could be reduced by 33% if only doctors and physiotherapists would pay attention here.
In my opinion, which is based on 28 years of clinical observation and practice, providing only exercises for the chronic low back sufferer described in this study is next to useless. This study is quite typical of a medical investigation for what it doesn’t tell us: what were the pain levels, flexibility and strength outcomes after exercise-only care? Do we now we have 77 middle-aged working people with 45 months of chronic back pain? Are these 77 patients any better off, or would zero sessions per week of supervised exercise have created the same clinical outcomes? Look at all the money saved there!
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