Exercise for Chronic Low Back or Neck Pain Study Title: Exercise prescription for chronic back or neck pain: Who prescribes it? Who gets it? What is prescribed? Author(s): Freburger JK, Carey TS, Holmes GM et al. Publication Information: Arthritis & Rheumatism (Arthritis Care & Research) 2009; 61(2): 192-200. BACkGrOUND INfOrMATION: In recent years, numerous high quality randomized trials and systematic reviews have supported the use of exercise for treating chronic low back pain (LBP) and neck pain. The goals of exercise include improving physical function and capacity, reducing symp- toms of pain and stiffness, minimizing kinesiophobia (fear of movement), and reshaping patients’ views on their pain (consistent with a cognitive-behavioural approach). It is still unclear which type of exercise is most efficacious, and in what dose. However, suggested that individually tailored, supervised exercise programs a recent meta-analysis1 including stretching and strengthening are associated with better outcomes in those with chronic low back pain. A further interesting finding from a different review by the same author2 was that high-intensity exercise (defined as more than 20 hours total) combined with conservative treatments improved pain and function more than exercise alone, or low inten- sity exercise. For chronic neck pain, the findings are similar, but not as conclusive. Current state- ments from the Bone and Joint Decade 2000-2010 Task Force on Neck Pain3 include: • supervised and home exercise with advice is slightly more effective than advice only for chronic whiplash-associated neck pain • exercise in addition to spinal manipulation is more effective than manipulation alone, TENS, or usual care for chronic neck pain • both endurance and strengthening exercise are effective treatments for chronic me- chanical neck pain • multi-modal approaches that include exercise are likely better than single-treatment approaches Despite this knowledge on the efficacy of exercise interventions, little is known about exercise prescription patterns in clinical practice. In particular: • Who is prescribing it? • What is being prescribed? • Who is getting it? Assessing these patterns would provide a good indication of the level of knowledge trans- lation that is occurring, and highlight areas for improvement. This was the goal of this study. PErTINENT rESULTS: • In over 2,700 chronic neck or back pain patients, exercise of some sort was pre- scribed to 48 per cent of patients who had seen a medical doctor (MD), physio- therapist (PT), or chiropractor in the past year. • Of this 48 per cent: 46 per cent received the prescription from a PT, 28.6 per cent from a physician, and 20.9 per cent from a chiropractor (4.6 per cent from “other”). • For those who saw a chiropractor – 33.1 per cent were prescribed exercise. • For those who saw a PT – 63.8 per cent were prescribed exercise. • For those who saw a physician – 14.4 per cent were prescribed exercise. • Overall, exercise prescription rates were not statistically different for back or neck pain. • All professions seemed to provide instructions for appropriate exercise duration (average approximately 3.5 hours per week) - following this recommendation for six weeks would achieve the 20-hour mark mentioned above that is supported for chronic LBP 16 • CANADIAN CHIROPRACTOR | APRIL 2009 Continued on page 20 www.canadianchiropractor.ca
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