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. 2023 Aug 30;2023(8):CD009365. doi: 10.1002/14651858.CD009365.pub2

Alt 2020.

Methods Study design: RCT
Recruitment period and mode: period: not reported; mode: subjects were recruited at a private physiotherapy department and by 4 external doctors.
Statistical analysis: the groups were compared according to each of the 5 measurement points. Afterwards, the comparability of the dependent time points of a group was used by means of the Friedmann test.
Sample size calculation: not reported
Participants Sample size: total: 44; EG: 22; CG: 22
Setting: private physiotherapy department
Country: Switzerland
Baseline characteristics

  • Age in years, mean (SD): 43.9 (10.8)

  • Sex, % women: EG: 59%; CG: 35%, numbers not extracted: text conflicts with Table 1


Duration LBP: < 6 weeks
Inclusion criteria

  • LBP ≤ 12 weeks

  • No physiotherapy for back problems for > 1 year

  • NRS minimum 3

  • Age 25–60 years

  • Heterogeneous gender identity


Exclusion criteria

  • Specific back injuries (disc hernia, fracture, osteoporosis etc.)

  • Steroidal drugs

  • Other forms of therapy (i.e. osteopathy, further physiotherapy etc.) during the whole research time (1 year before unit 1 to 16 weeks after unit 9)

  • 1 or more known or suspected severe spine pathologies (fractures, tumours, inflammation, rheumatic diseases, or infectious diseases of the spine)

  • Planned or previous spinal surgery

  • Comorbid health conditions (hypertension, pregnancy, or severe cardiovascular diseases)
Interventions EG: progressive exercise with counselling units

  • Description: exercises divided into 3 specific phases, the intensities of which were changed after 3 units per phase. The desired load frame was always performed in the same way. Each exercise was adapted to the participant's condition, which corresponds to the degree of disability according to the ODI. Phase 1: exercises such as the Superman exercise. 2–3 sets of 5–10 repetitions deadlifts. Phase 2: aimed to increase confidence in one's own motor skills, decentralise the focus on pain, build up motor and mental resilience, and reduce fear of back strain. 8–12 repetitions including lunges, activation of the oblique trunk musculature against resistance at the cable pull. Phase 3: aimed to encourage the participant to cope with his problematic activities (e.g. lifting) and to develop autonomy

  • Materials/equipment: cable pull

  • Non‐exercise component: counselling units: 2 times at 1st and 9th visits to calm the participant, explain the pain and the helpful measures and show the positive aspects of the treatment, such as the possibility to walk and having no limiting symptoms, such as numb feelings or motoric failures

  • Frequency and duration: 9 units, each lasting 30–45 minutes, up to 2–3 sessions per week

  • Delivery: individual supervised session

  • Provider: PT


CG: manual therapy with counselling units

  • Description: manual therapy: consisting of lumbar and SI mobilisation (Maitland concept) and massage to the lumbar spine and buttocks

  • Counselling units: similar to EG

  • Frequency and duration: 9 units, each lasting 30–45 minutes, up to 2–3 sessions per week

  • Delivery: individual supervised session

  • Provider: PT
Outcomes Note: Outcomes were not designated as major or minor outcomes
Pain: NRS 0‐10

  • Baseline, mean (SD): EG: 4.8 (1.2); CG: 4.4 (1.4)

  • After the 5th treatment, mean (SD): EG: 2.3 (0.8); CG: 2.4 (1.2)

  • 3–4 weeks, pain after the 9th treatment, mean (SD): EG: 0.7 (0.7); CG: 1.1 (1.1)

  • 6 weeks, mean (SD): EG: 0.4 (0.6); CG: 1.3 (0.9)

  • 16 weeks, mean (SD): EG: 0.0 (0.0); CG: 1.7 (9.5)


Functional status: ODI

  • Baseline, mean (SD): EG: 32.5 (12.8); CG: 36.8 (8.5)

  • After the 5th treatment, mean (SD): EG: 18.2 (10.5); CG: 19.1 (7.2)

  • 3–4 weeks, after the 9th treatment, mean (SD): EG: 4.8 (7.1); CG: 9.1 (2.8)

  • 6 weeks, mean (SD): EG: 2.3 (6.2); CG: 8.5 (2.5)

  • 16 weeks, mean (SD): EG: 0.3 (7.7); CG: 9.6 (0.8)


Adverse events: no important adverse effects of treatment were reported in any of the groups
Notes Authors' results and conclusions: especially in the long term (measurements 4 and 5), the significant statistical results between the groups indicate that EG is more successful than CG in reducing pain and disability.
Review authors' note: although results are statistically significant, they are not clinically relevant.
Funding: not reported
Declaration of interest: the study authors have no conflict of interest.