Does physical activity change predict functional recovery in low back pain? Protocol for a prospective cohort study Recurrent non-specific low-back pain in adolescents: the role of exercise Physical performance, pain, pain behavior and subjective disability in patients with subacute low back pain. Implementation of a multidisciplinary program for active duty personnel seeking care for low back pain in a U.S. Navy Medical Center: a feasibility study. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. The Predictive Relationship of Physical Activity on the Incidence of Low Back Pain in an Occupational Cohort It's time for change with the management of non-specific chronic low back pain Movement control exercise versus general exercise to reduce disability in patients with low back pain and movement control impairment. A randomised controlled trial Does a patient’s physical activity predict recovery from an episode of acute low back pain? A prospective cohort study The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain How does the self-reported clinical management of patients with low back pain relate to the attitudes and beliefs of health care practitioners? A survey of UK general practitioners and physiotherapists Self-Report Measures Best Explain Changes in Disability Compared With Physical Measures After Exercise Rehabilitation for Chronic Low Back Pain Non-specific low back pain in primary care in the Spanish National Health Service: a prospective study on clinical outcomes and determinants of management Active Lifestyle Protects Against Incident Low Back Pain in Seniors: A Population-Based 2-Year Prospective Study of 1387 Danish Twins Aged 70–100 Years Low back pain incident episodes: a community-based study. The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach. Low Back Pain in a General Population. Natural Course and Influence of Physical Exercise–A 5-Year Follow-up of the Musculoskeletal Intervention Center-Norrtälje Study
Background Activity advice and prescription are commonly used in the management of low back pain ( LBP ) . Although there is evidence for advising patients with LBP to remain active , facilitating both recovery and return to work , to date no research has assessed whether objective measurements of free living physical activity ( PA ) can predict outcome , recovery and course of LBP . Methods An observational longitudinal study will investigate  PA  levels in a cohort of community-dwelling working age adults with acute and sub-acute LBP . Each participant 's  PA level , functional status , mood , fear avoidance behaviours , and levels of pain , psychological distress and occupational activity  will be measured on three occasions during for 1 week periods at baseline , 3 months , and 1 year .  Physical activity levels  will be measured by self report , RT3 triaxial accelerometer , and activity recall question naires . The primary outcome measure of functional recovery will be the Rol and Morris Disability Question naire ( RMDQ ) . Free living PA levels and changes in functional status will be quantified in order to look at predictive relationships between levels and changes in free living PA and functional recovery in a LBP population . Discussion This research will investigate levels and changes in activity levels of an acute LBP cohort and the predictive relationship to LBP recovery . The results will assess whether occupational , psychological and behavioural factors affect the relationship between free living PA and LBP recovery . Results from this research will help to determine the strength of evidence supporting international guidelines that recommend restoration of normal activity in managing LBP.Trial registration [ Clinical Trial Registration Number , ACTRN12609000282280 This study evaluated the efficacy of an exercise programme as an intervention for  recurrent non-specific low-back pain ( NLSBP ) in adolescents . A r and omized controlled trial was conducted with an experimental group ( n = 27 , age 14.6 years ) who participated in an 8-week exercise programme and a matched control group ( n = 27 , age 14.6 years ) who continued normal daily activities . All participants suffered from recurrent NSLBP . Pre and post intervention measures of NSLBP status ( pain severity and consequences ) and daily inactivity ( time spent sitting , PC time , TV time ) were reported in one week diaries . Two-way mixed ANOVA ( independent variables : pre/post and experimental/control ) was conducted for each dependent variable , significance was set at P < 0.05 . Significant interaction effects were identified for the severity of pain , number of occasions missing sport due to NSLBP and amount of sport participated in . In each case the experimental group benefited from the exercise programme . In contrast , no significant interaction effects were observed for physical inactivity , both groups spent a similar amount of time sitting , watching TV and using a PC pre- and post- intervention . It was concluded that an exercise programme acted as an effective short-term treatment strategy for NSLBP in adolescents . Further evaluation is required to assess the long-term effectiveness The aim of this paper was to study the physical performance , pain , pain behavior and disability in patients with subacute low back pain ( LBP ) . The patients were blue-collar workers and had been sick-listed for 8 weeks due to subacute low back pain . A total of 103 patients were r and omized , 51 of them to the intervention group and the other to a control group .  Recordings of physical performance and complaints of LBP were done before and after treatment in the intervention group . The proportion of patients with no complaints of LBP was significantly greater in the intervention group than in the control group at the one-year follow-up . The patients who intra-individually improved their physical performance also intra-individually decreased their complaints of LBP . The intra-individual improvements were suggested to be important for the individual return to work The aim of the pilot study was to evaluate a multidisciplinary program for nonspecific low back pain ( NSLBP ) at a major U.S. Navy base . In this single blinded r and omized clinical trial , subjects were drawn from a larger , prospect i ve cohort of active duty service members seeking care for NSLBP pain at a U.S. Navy Branch Medical Clinic . Outcome measures included return to work , self-reported pain , function , and psychological distress . Subjects were r and omly allocated to one of two study arms : a multidisciplinary reconditioning program or the current st and ard of care for low back pain . The intervention lasted 4 weeks with a 12-week follow-up . Thirty-three subjects were enrolled . Subjects allocated to multidisciplinary care reported significantly lower perceived disability ( p = 0.014 ) and less pain than those allocated to usual care at the end of the intervention period . All subjects returned to their usual duty following the conclusion of the intervention . The implementation of the intervention program was successful . Subjects in the multidisciplinary program showed a clinical ly significant improvement in the perception of disability compared to the usual care group . This is an important finding since perception of disability is associated with long-term functional outcome OBJECTIVE To develop a clinical prediction rule to predict treatment response to a stabilization exercise program for patients with low back pain ( LBP ) . DESIGN A prospect i ve , cohort study of patients with nonradicular LBP referred to physical therapy ( PT ) . SETTING Outpatient PT clinics . PARTICIPANTS Fifty-four patients with nonradicular LBP . INTERVENTION A st and ardized stabilization exercise program . MAIN OUTCOME MEASURE Treatment response ( success or failure ) was categorized based on changes in the Oswestry Disability Question naire scores after 8 weeks . RESULTS Eighteen subjects were categorized as treatment successes , 15 as treatment failures , and 21 as somewhat improved . After using regression analyses to determine the association between st and ardized examination variables and treatment response status , preliminary clinical prediction rules were developed for predicting success ( positive likelihood ratio [ LR ] , 4.0 ) and failure ( negative LR , .18 ) . The most important variables were age , straight-leg raise , prone instability test , aberrant motions , lumbar hypermobility , and fear-avoidance beliefs . CONCLUSIONS It appears that the response to a stabilization exercise program in patients with LBP can be predicted from variables collected from the clinical examination . The prediction rules could be used to determine whether patients with LBP are likely to benefit from stabilization exercises Objective : Quantify the relationship between physical activity and development of  incident low back pain ( LBP ) .  Methods : This nested prospect i ve cohort study utilized an objective measure of physical activity in 68 participants with 30 incident cases of LBP .  Physical activity was divided into tertiles and quartiles . Univariate and multivariate relative risks and hazard ratios were calculated . Results : Comparing highest to middle tertile of light activity demonstrated a statistically significant relative risk of 3.68 for developing incident LBP . Lowest and highest tertile of minutes of moderate/vigorous activity yielded statistically significant relative risks of 4.60 and 6.14 , respectively . Multivariate analyses demonstrated similar associations . Conclusions : Moderate amounts of physical activity were protective for the development of LBP  in this cohort , after adjustment for risk factors . This nonlinear relationship suggests higher levels of activity do not confer increased LBP prevention Low back pain ( LBP ) is the second greatest cause of disability in the USA.1 USA data supports that in spite of an enormous increase in the health re sources spent on LBP disorders , the disability relating to them continues to increase.2 The management of LBP is underpinned by the exponential increase in the use of physical therapies , opiod medications , spinal injections as well as disc replacement and fusion surgery.2 This is maintained by the underlying belief that LBP is fundamentally a patho-anatomical disorder and should be treated within a biomedical model.1 This is in spite of calls over a number of years to adopt a bio-psycho-social approach , and evidence that only 8–15 % of patients with LBP have an identified patho-anatomical diagnosis , result ing in the majority being diagnosed as having non-specific LBP.3 Of this population , a small but significant group becomes chronic and disabled , labelled non-specific chronic low back pain ( NSCLBP ) , consuming a disproportionate amount of healthcare re sources .4 1 . Over the past decade , the traditional biomedical view of LBP has been greatly challenged . This is a result of : the failure of simplistic single-dimensional therapies to show large effects in patients with NSCLBP5–8 ; 2 . the results of clinical trials testing commonly prescribed interventions demonstrating that no management approaches are clearly superior5–7 9 ; 3 . the stories of NSCLBP patients relating their own ongoing pain experiences of multiple failed treatments , conflicting diagnoses , lost hope and ongoing suffering10 ; 4 . the indisputable evidence supporting the multidimensional nature of NSCLBP as a disorder , where disability levels are more closely associated with cognitive and behavioural aspects of pain rather than sensory and biomedical ones11 12 ; 5 . positive outcomes in r and omised controlled trials ( RCTs ) are best predicted by changes in psychological distress , fear avoidance beliefs , self-efficacy in Background Non-specific low back pain ( NSLBP ) in subacute and chronic stages can be treated effectively with exercise therapy . Research guidelines recommend evaluating different treatments in defined subgroups of patients with NSLBP . A subgroup of patients with movement control impairment ( MCI ) improved significantly on patient specific function and disability in a previous case series after movement control exercises . Methods / Design In a r and omised controlled trial ( RCT ) we will compare the effectiveness of movement control and general exercise in patients with MCI . 106 participants aged 18 - 75 will be recruited in 5 outpatient hospital departments and 7 private practice s. Patients r and omly assigned to the movement control exercise group will be instructed to perform exercises according to their MCI . The general exercise group will follow an exercise protocol aim ed at improving endurance and flexibility . Patients in both groups will receive 9 - 18 treatments and will be instructed to do additional exercises at home . The primary outcome is the level of disability assessed using the patient specific functional scale ( PSFS ) which links the perceived pain to functional situations and is measured before treatment and at 6 and 12 months follow-up . Secondary outcomes concern low back pain related disability ( Rol and Morris question naire , RMQ ) , grade d chronic pain scale ( GCPS ) , range of motion and tactile acuity . Discussion To our knowledge this study will be the first to compare two exercise programs for a specific subgroup of patients with NSLBP and MCI . Results of this study will provide insight into the effectiveness of movement control exercise and contribute to our underst and ing of the mechanisms behind MCI and its relation to NSLBP.Trial registration Current Controlled Trials IS RCT Background Advice to remain active and normalisation of activity are commonly prescribed in the management of low back pain ( LBP ) . However , no research has assessed whether objective measurements of physical activity predict outcome and recovery in acute low back pain . Method The aims of this study were to assess the predictive relationship between activity and disability at 3 months in a sub-acute LBP population . This prospect i ve cohort study recruited 101 consenting patients with sub-acute LBP ( < 6 weeks ) who completed the Rol and Morris Disability Question naire ( RMDQ ) , the Visual Analogue Scale , and resumption of full ‘ normal ’ activity question ( Y/N ) , at baseline and 3 months .  Physical activity  was measured for 7 days at both baseline and at 3 months with an RT3 accelerometer and a recall question naire . Results Observed and self-reported measures of physical activity at baseline and change in activity from baseline to 3 months were not independent predictors of RMDQ ( p > 0.05 ) or RMDQ change ( p > 0.05 ) over 3 months . A self-report of a return to full ‘ normal ’ activities was significantly associated with greater RMDQ change score at 3 months ( p < 0.001 ) . Paired t-tests found no significant change in activity levels measured with the RT3 ( p = 0.57 ) or the recall question naire ( p = 0.38 ) from baseline to 3 months . Conclusions These results question the predictive role of physical activity in LBP recovery , and the assumption that activity levels change as LBP symptoms resolve . The importance of a patient ’s perception of activity limitation in recovery from acute LBP was also highlighted . Trial registration Clinical Trial Registration Number , Background The impact of the relationship ( therapeutic alliance ) between patients and physical therapists on treatment outcome in the rehabilitation of patients with chronic low back pain ( LBP ) has not been previously investigated . Objective The purpose of this study was to investigate whether the therapeutic alliance between physical therapists and patients with chronic LBP predicts clinical outcomes . Design This was a retrospective observational study nested within a r and omized controlled trial . Methods One hundred eighty-two patients with chronic LBP who volunteered for a r and omized controlled trial that compared the efficacy of exercises and spinal manipulative therapy  rated their alliance with physical therapists by completing the Working Alliance Inventory at the second treatment session . The primary outcomes of function , global perceived effect of treatment , pain , and disability were assessed before and after 8 weeks of treatment . Linear regression models were used to investigate whether the alliance was a predictor of outcome or moderated the effect of treatment . Results The therapeutic alliance was consistently a predictor of outcome for all the measures of treatment outcome . The therapeutic alliance moderated the effect of treatment on global perceived effect for 2 of 3 treatment contrasts ( general exercise versus motor control exercise , spinal manipulative therapy versus motor control exercise ) . There was no treatment effect modification when outcome was measured with function , pain , and disability measures . Limitations Therapeutic alliance was measured at the second treatment session , which might have biased the interaction during initial stages of treatment . Data analysis was restricted to primary outcomes at 8 weeks . Conclusions Positive therapeutic alliance ratings between physical therapists and patients are associated with improvements of outcomes in LBP . Future research should investigate the factors explaining this relationship and the impact of training interventions aim ed at optimizing the alliance & NA ; Guidelines for the management of low back pain ( LBP ) have existed for many years , but adherence to these by health care practitioners ( HCPs ) remains suboptimal . The aim of this study was to measure the attitudes , beliefs and reported clinical behaviour of UK physiotherapists ( PTs ) and general practitioners ( GPs ) about LBP and to explore the associations between these . A cross‐sectional postal survey of GPs ( n = 2000 ) and PTs ( n = 2000 ) was conducted that included the  Pain Attitudes and Beliefs Scale ( PABT.PT )  , and a vignette of a  patient with non‐specific LBP ( NSLBP )  with questions asking about recommendations for work , activity and bedrest . Data from 1022 respondents ( 442 GPs and 580 PTs ) who had recently treated patients with LBP were analysed . Although the majority of HCPs reported providing advice for the vignette patient that was broadly in line with guideline recommendations , 28 % reported they would advise this patient to remain off work . Work advice was significantly related to the PABS.PT scores with higher biomedical ( F1,986 = 77.5 , p < 0.0001 ) and lower behavioural ( F1,981 = 31.9 , p < 0.001 ) scores associated with advice to remain off work . We have demonstrated that the attitudes and reported practice behaviour of UK GPs and PTs for patients with NSLBP are diverse . Many HCPs held the belief that LBP necessitates some avoidance of activities and work . The attitudes and beliefs of these HCPs were associated with their self‐reported clinical behaviour regarding advice about work . Future studies need to investigate whether approaches aim ed at modifying these HCP factors can lead to improved patient outcomes Study Design . Sixteen-week intervention for chronic patients with low back pain ( LBP ) with 9-month follow-up . Primary r and omization at 4 weeks into either supervised Swiss ball exercise or an exercise advice group . Objective . To evaluate changes in disability and pain in individuals with chronic LBP after combined treatment and exercise interventions  , and to evaluate whether changes in self-report or physical measures would best explain improvements in disability Summary of Background Data . There is a need to underst and what the effectiveness of a clinical ly applicable treatment intervention is for an individual ’s perception of their back pain . There is insufficient evidence about the different combinations of manual treatment that commonly precede involvement in exercise programs . Methods . Sixty individuals with chronic nonspecific LBP ( at least 3-month duration ) were r and omly assigned ( after 4 weeks of manipulative or nonmanipulative treatment ) to either a supervised Swiss ball exercise group , or an advice group . The exercise intervention was for 12 weeks with a long-term follow-up of 9 months . Self-report measures and physical measures ( endurance times and myoelectric fatigue ) were collected throughout the study . Results . Self-rated disability improved more after the treatment period for individuals who received supervised exercise compared with advice alone . There was no difference found between individuals who received manipulative or nonmanipulative treatment . Multiple regression analysis found that self-report measures best explained improvements in disability throughout the study . Long-term findings showed no group differences . Conclusion . Supervised exercise is a more successful subsequent to manual treatment compared with exercise advice . The improvements associated with this type of program were primarily manifested in the psychologic self-report measures rather than physical measurements Background The Spanish National Health Service is a universal and free health care system . Non-specific low back pain ( LBP ) is a prevalent disorder , generating large health and social costs . The objectives of this study were to describe its management in primary care , to assess patient characteristics that influence physicians ' decisions , and to describe clinical outcome at 2 months . Methods A cross-sectional sample of 648 patients with non-specific low back pain was recruited by 75 physicians ( out of 361 – 20.8 % ) working in 40 primary care centers in 10 of the 17 administrative regions in Spain , covering 693,026 out of the 40,499,792 inhabitants . Patients were assessed on the day they were recruited , and prospect ively followed-up 14 and 60 days later . The principal patient characteristics that were analyzed were : sex , duration of the episode , history of LBP , working status , severity of LBP , leg pain and disability , and results of straight leg raising test . Descriptors of management were : performance of the straight leg raising test , ordering of diagnostic procedures , prescription of drug treatment , referral to physical therapy , rehabilitation or surgery , and granting of sick leave . Regression analysis was used to analyze the relationship between patients ' baseline characteristics and physicians ' management decisions . Only workers were included in the models on sick leave . Results Mean age ( SD ) of included patients was 46.5 ( 15.5 ) years , 367 ( 56.6 % ) were workers , and 338 ( 52.5 % ) were females . Median ( 25th–75th interquartile range ) duration of pain when entering the study was 4 ( 2–10 ) days and only 28 patients ( 4.3 % ) had chronic low back pain . Diagnostic studies included plain radiographs in 43.1 % of patients and CT or MRI scans in 18.8 % . Drug medication was prescribed to 91.7 % of patients , 19.1 % were sent to physical therapy or rehabilitation , and 9.6 % were referred to surgery . The main determinants of the clinical management were duration of the episode and , to a lesser extent , the intensity of the pain ( especially leg pain ) , a positive straight leg raising test , and degree of disability . The main determinant of sick leave was the degree of disability , followed by the characteristics of the labor contract and the intensity of leg pain ( but not low back pain ) . After at least 2 months of treatment , 37 % of patients were still in pain and approximately 10 % of patients had not improved or had worsened . Conclusion Although the use of X-Rays is high , determinants of physicians ' management of LBP in primary care made clinical sense and were consistent with patterns suggested by evidence -based recommendations . However , after 2 months of treatment more than one third of patients continued to have back pain and about 10 % had worsened Study Design . Prospect i ve cohort study of twins . Objectives . To investigate associations between physical activity , physical function , and incident low back pain ( LBP ) in an elderly population . Summary of Background Data . The relationship between an active lifestyle and LBP in seniors is unknown . Methods . Participants in the population -based Longitudinal Study of Aging Danish Twins free from LBP at baseline ( no LBP during the past month ) were included , and interview data on physical activity , overall physical function , and LBP at baseline and follow-up were obtained . Associations between levels of  physical activity and LBP were estimated using logistic regression for the entire cohort , and using a matched case-control design for twin pairs discordant for physical activity . Absolute risk and relative risks for incident LBP in relation to physical activity were calculated for participants with higher or lower than average physical function at baseline . Absolute risk for LBP was also calculated for participants based on whether they remained active or inactive between baseline and follow-up or changed activity level . Results . A total of 1387 persons aged 70–100 at baseline were included in the analyses , including 86 twin pairs discordant for physical activity at baseline . In the total sample , 83 % were engaged in light physical activity  , and 42 % of men and 35 % of women were engaged in strenuous  physical activity  at least weekly . Being engaged in strenuous physical activity at baseline was strongly protective in relation to both having had any LBP ( odds ratio 0.21 , 95 % confidence interval 0.12–0.37 for intra-pair analysis ) and having had LBP lasting more than 30 days altogether during the past year at follow-up ( odds ratio 0.08 , 95 % confidence interval 0.03–0.18 for intra-pair analysis ) . Statistically significant dose-response associations between increasing frequency of strenuous physical activity and magnitude of this protective effect were found . Participants with poor initial physical function experienced the strongest protective effect of strenuous physical activity . Finally , LBP does not appear to be an important factor affecting whether participants remained engaged in strenuous physical activity at baseline and follow-up or vice versa . Conclusions . Strenuous physical activity at least once a week is protective for incident LBP in seniors BACKGROUND CONTEXT The available evidence regarding low back pain ( LBP ) incident episodes is not consistent . Such knowledge can add information for the potential contribution of preventive programs . PURPOSE a ) To evaluate annual incident episodes of LBP among the general population . b ) To evaluate the contribution of demographic , lifestyle , and back pain history to LBP incident episodes . STUDY DESIGN A community-based longitudinal study . PATIENT SAMPLE A r and omized sample of individuals , free of LBP at a previous cross-sectional survey . OUTCOME MEASURES Low back pain during the past year . METHODS Subjects were followed up after 1 year . Baseline data included back pain history , perception of general health , physical activity , smoking , work satisfaction , and demographic characteristics . RESULTS Annual incident episodes of LBP were 18.4 % . Those who experienced LBP during the past year had a lower baseline perception of general health and were less involved in sporting activities than those free of pain . Those without history of LBP were more likely to be free of back pain after 1 year . CONCLUSIONS The annual incident episodes of LBP are relatively high and relate indirectly to baseline perception of general health and to level of sporting activities . Those without history of LBP are more likely to be free of back pain after 1 year . These results raise the potential of LBP preventive programs for adult population The aim of this study was to determine whether grade d activity restored occupational function in industrial blue-collar workers who were sick-listed for 8 weeks because of subacute , nonspecific , mechanical low back pain ( LBP ) . Patients with LBP , who had been examined by an orthopedic surgeon and a social worker , were r and omly assigned to either an activity group ( n = 51 ) or a control group ( n = 52 ) . Patients with defined orthopedic , medical , or psychiatric diagnoses were excluded before r and omization . The grade d activity program consisted of four parts : ( 1 ) measurements of functional capacity ; ( 2 ) a work-place visit ; ( 3 ) back school education ; and ( 4 ) an individual , submaximal , gradually increased exercise program , with an operant-conditioning behavioral approach , based on the results of the tests and the dem and s of the patient 's work . Records of the amount of sick leave taken over a 3-year period ( ie , the 1-year periods before , during , and after intervention ) were obtained from each patient 's Social Insurance Office . The patients in the activity group returned to work significantly earlier than did the patients in the control group . The median number of physical therapist appointments before return to work was 5 , and the average number of appointments was 10.7 ( SD = 12.3 ) . The average duration of sick leave attributable to LBP during the second follow-up year was 12.1 weeks ( SD = 18.4 ) in the activity group and 19.6 weeks ( SD = 20.7 ) in the control group . Four patients in the control group and 1 patient in the activity group received permanent disability pensions . The grade d activity program made the patients occupationally functional again , as measured by return to work and significantly reduced long-term sick leave Study Design . A 5-year prospect i ve cohort study was conducted of men and women seeking care for a new period of low back pain ( LBP ) . Objectives . To study the natural course of pain and disability due to LBP during a 5-year follow-up period , and to investigate the possible influence of regular physical exercise on recovery . Summary of Background Data . LBP is major health problem , but its natural course is not very well studied . Several studies have investigated the role of physical exercise on LBP disorders , with inconsistent results . Methods . At baseline , a total of 790 subjects seeking care for LBP were interviewed about physical exercise during leisure time . Over 5 years , 3 follow-up assessment s were made by postal question naire . At all measuring points , pain intensity ratings and disability scores were compared between men and women , and among 3 exercise categories . Results . The pain intensity and disability scores were improved after 5 years for both men and women . The most prominent improvements occurred after 6 months , but less so thereafter . There were no significant differences between men and women with regard to individual changes at the 5-year follow-up concerning the pain intensity or disability scores . There were no significant differences , either for women or men , between low , median , or high intensity exercise groups regarding pain intensity or disability values for the individual change at the 5-year follow-up . Conclusions . Over a 5-year period , both men and women who had sought care for LBP reported a decrease in pain and disability ; however , only a few were fully restored . In this study , we found no effect of nonspecific physical exercise on recovery from LBP in men and women
These data suggest that the activity levels of patients with NSLBP are neither associated with , nor predictive of , disability or pain levels .
Although clinical guidelines advocate exercise and activity in the management of non-specific low back pain ( NSLBP ) , the link between levels of physical activity and outcomes is unclear .
This systematic review investigated the relationships between free living activity levels  after onset of low back pain ( LBP ) and measures of pain , and disability in patients with NSLBP .