Rhee 2012.
| Methods | Randomised controlled trial | |
| Participants | 21 patients included Inclusion criteria: participants were recruited from the greater city Seoul, Korea. Participants who expressed interest in the study became eligible for the study. Those participants who met study inclusion criteria received information regarding the purpose and methods of the study and signed a copy of the Institutional Review Board approved consent form. In this study, patients with recurrent LBP were defined as those who met study inclusion criteria and experienced a disturbing impairment or abnormality in the functioning of the low back. The patients with recurrent LBP were defined as those who previously experienced at least 1 episode of work‐related back pain. Current diagnoses and prior injury data were based on both a physician's history and physical exam results, which were obtained from the patients' records. Participants were eligible to participate if they: 1) were 21 years of age or older, 2) had at least 1 episode of work‐related back pain without referred pain into the lower extremities, and 3) indicated a willingness to participate in a daily exercise programme and in supervised exercise sessions 5 times a week for 4 weeks during the intervention period. Exclusion criteria: participants were excluded from participation if they: 1) had a diagnosed mental illness that might interfere with the study protocol, 2) had difficulty in understanding written/spoken English that precluded them from completing questionnaires, 3) had overt neurological signs (sensory deficits or motor paralysis), or 4) were pregnant |
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| Interventions |
Spinal stabilisation exercise (SSE): 3 times per week, 4 weeks (5 times per week ‐ home exercise). The SSE protocol was designed to improve spinal stabilisation through core muscle strengthening rather than to improve spinal stabilisation through low back muscles endurance or strengthening. The SSE group performed specific localised exercises aimed at restoring the stabilising protective function of the spinal muscles around the spinal joint. As applied by several authors, the exercises were designed specifically to activate and train the isometric holding function of the spinal muscle at the affected vertebral segment (in co‐contraction with the transversus abdominis muscle); this rehabilitation approach is described in detail. Patients from the SSE group were seen 3 times per week, but performed the exercises 5 times per week at home. In addition to performing home exercises, the patients performed the 20‐minute exercise session in the lab (supervised by the research co‐ordinator) 3 times per week for 4 weeks to ensure that the exercises were being performed correctly. Patients kept an exercise log, and phone calls were made to ensure compliance with the exercise protocol. Control group (advice only): the control group received a hard copy of medical management techniques, which included advice regarding bed rest, absence from work, prescription medications and resuming normal activity as tolerated |
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| Outcomes | Pain (VAS 0 to 100) Disability (Oswestry Disability Index (ODI)) |
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| Notes | — | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "A randomisation list was provided, with patients having an equal chance of being allocated to the intervention or control group. The coordinator ensured anonymity of allocation with respect to randomisation" |
| Allocation concealment (selection bias) | Low risk | "The randomisation schedule was prepared prior to the beginning of the trial, and the coordinator was given a sealed envelope for each patient before the assessment" |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | No mention of any attempts to blind the participants |
| Blinding of personnel/care provider (performance bias) All outcomes | High risk | No mention of any attempts to blind the care provider |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | No mention of any attempts to blind the assessor |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | No information regarding dropouts |
| Intention‐to‐treat analysis | High risk | No mention of intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Low risk | No previous protocol or trial registration, but it was clear that the published report included all expected outcomes |
| Group similarity at baseline (selection bias) | High risk | We did not consider the groups to be similar at baseline regarding the outcomes included in this review |
| Co‐interventions (performance bias) | Unclear risk | Not described |
| Compliance (performance bias) | Low risk | Compliance was acceptable for both groups |
| Timing of outcome assessment (detection bias) | Low risk | All important outcome assessments for both groups were measured at the same time |