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W1.3

Title:  Exercise as a treatment for sub-acute low back pain

Authors and affiliation: J. Bart Staal 1, Julie Fritz 2, James Rainville 3, William Shaw 4

1 Dept of Epidemiology, Maastricht University, Maastricht, The Netherlands
2 Div of Physical Therapy, University of Utah, Salt Lake City, UT, USA.
3 Dept of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
4 Liberty Mutual Research Institute for Safety, Hopkinton, MA USA

Email addresses for co-chairs: bart.staal@EPID.unimaas.nl & william.shaw@libertymutual.com

Introduction: While there is consistent evidence that exercise is an effective treatment for chronic low back pain, its efficacy for sub-acute low back pain remains controversial, and the mechanisms by which exercise reduces back pain and disability are not well understood.  A number of important research questions remain, including whether certain subgroups of patients are more likely to benefit from exercise, which types of exercise are most effective, whether benefits are mediated principally by physical or psychological changes, whether compliance with home exercise and physical activity recommendations can be improved, and whether exercise outcomes can be enhanced by using cognitive/behavioral strategies.  Objective: The goal of the workshop is to identify future research directions that will provide a stronger evidence base for evaluating benefits of exercise in the treatment of sub-acute low back pain.

Methods / content: In this 90-minute workshop session, a panel of four researchers will provide a brief summary of their research observations and insights (10 minutes each) related to the discussion questions listed below.  Presentations by panelists will provide background and raise points for group discussion without the presentation of specific study results.  These presentations will serve as a catalyst for a larger group discussion (50 minutes) among participants that will be facilitated by the four panelists.  Research issues to be addressed include the following:    
(1) How does exercise improve pain and disability outcomes for sub-acute low back pain? What are the various mechanisms or theories that best explain its potential benefits?
(2) What are the various forms of exercise that have been studied as possible treatments for sub-acute LBP?  What are the most meaningful distinctions in exercise types for studying potential differences in efficacy?
(3) When and for whom are exercise interventions most effective?  What patient populations should be the focus of future studies?
(4) How has exercise research been impacted by professional boundaries, insurance reimbursement, treatment guidelines, cost considerations, and other systemic factors? Following the group discussion, panelists and other interested parties will be invited to co-author a scientific paper summarizing the results of the workshop and providing an agenda for future research in this field.  A topical outline of the paper will be circulated in advance of the workshop.