Group outpatient physical and behavioral therapy for chronic low back pain. Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. A study of therapeutic ultrasound and exercise treatment for muscle fatigue in patients with chronic non specific low back pain: a preliminary report. Efficacy of graded activity versus supervised exercises in patients with chronic non-specific low back pain: protocol of a randomised controlled trial Enhanced implementation of low back pain guidelines in general practice: study protocol of a cluster randomised controlled trial Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Reliability and Validity of a New Objective Tool for Low Back Pain Functional Assessment The Therapeutic Alliance Between Clinicians and Patients Predicts Outcome in Chronic Low Back Pain Spinal Cord Injury Rehabilitation Evidence: Methods of the SCIRE Systematic Review. Cost-effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for nonspecific low back pain: design of a stepped-wedge cluster randomised controlled trial [Back school for patients with non-specific chronic low-back pain: benefits from the association of an exercise program with patient's education]. Interventional Therapies, Surgery, and Interdisciplinary Rehabilitation for Low Back Pain: An Evidence-Based Clinical Practice Guideline From the American Pain Society Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management The effectiveness of manual therapy, physiotherapy and continued treatment by the general practitioner for chronic nonspecific back and neck complaints: design of a randomized clinical trial. Prognosis and Course of Disability in Patients With Chronic Nonspecific Low Back Pain: A 5- and 12-Month Follow-up Cohort Study The role of patients' expectation of appropriate initial manual therapy treatment in outcomes for patients with low back pain. IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT): Cluster randomised controlled trial study protocol
Conducted a treatment- outcome study to investigate the effectiveness of behavioral ( BT ) or physical therapy ( PT ) for treating chronic low back pain ( CLBP ) . Thirteen patients received BT ; 12 patients received PT . All patients had at least a 6-month history of seeking treatment of CLBP . Prior to treatment patients were assessed in four principal areas of functioning : ( 1 ) physical abilities ; ( 2 ) current physical functioning ; ( 3 ) psychological and psychosocial functioning ; and ( 4 ) pain intensity and pain perception . Treatments were conducted in a group ( 5 - 8 patients ) outpatient setting . Both BT and PT met for 10 weekly 2-hour sessions . BT was design ed to address the environmental , social , and emotional influences of the pain experience , depression , and decreased activity from CLBP . PT was based upon traditional rehabilitation theory and was design ed to improve low back function . The posttreatment results showed general improvement for patients in both groups , but few treatment-specific differences in outcome measures BACKGROUND CONTEXT Low back pain ( LBP ) is a prevalent disorder in society that has been associated with increased loss of work time and medical expenses . A common intervention for LBP is spinal manipulation , a technique that is not specific to one scope of practice or profession . PURPOSE The purpose of this systematic review was to examine the effectiveness of physical therapy spinal manipulations for the treatment of patients with low back pain . METHODS A search of the current literature was conducted using PubMed , CINAHL , SPORTD iscus , Pro Quest Nursing and Allied Health Source , Scopus , and Cochrane Controlled Trials Register . Studies were included if each involved : 1 ) individuals with LBP ; 2 ) spinal manipulations performed by physical therapists compared to any control group that did not receive manipulations ; 3 ) measurable clinical outcomes or efficiency of treatment measures , and 4 ) r and omized control trials . The quality of included articles was determined by two independent authors using the criteria developed and used by the Physiotherapy Evidence Data base ( PEDro ) . RESULTS Six r and omized control trials met the inclusion criteria of this systematic review . The most commonly used outcomes in these studies were some variation of pain rating scales and disability indexes . Notable results included varying degrees of effect sizes favoring physical therapy spinal manipulations and minimal adverse events result ing from this intervention . Additionally , the manipulation group in one study reported statistically significantly less medication use , health care utilization , and lost work time . CONCLUSION Based on the findings of this systematic review there is evidence to support the use of spinal manipulation by physical therapists in clinical practice . Physical therapy spinal manipulation appears to be a safe intervention that improves clinical outcomes for patients with low back pain AIM The aim of this study was to investigate the effect of continuous ultrasound ( US ) plus exercise on the endurance of paravertebral muscles of patients with chronic non specific low back pain ( CNSLBP ) . METHODS AND MATERIAL S In this pilot , pretest-posttest study , 22 patients with CNSLBP participated . Patients received 10 sessions of treatment , including continuous US plus exercise therapy , over a period of four consecutive weeks . Median frequency slopes of Iliocostalis and Multifidus muscles as well as holding time during Biering-Sorensen test were measured using surface electromyography . In addition , function and pain were measured using Functional Rating Index ( FRI ) question naire and VAS . RESULTS Five females and 15 males with a mean age of 31.7 years completed the treatment . Descriptive data showed a decrease of 0.01 and 0.02 mean in median frequency slope of right and left Iliocostalis respectively and a mean of 0.08 decrease for both right and left Multifidus muscles . Endurance time increased 1.8 seconds mean . Both function ( 17 % ) and pain ( 24 % ) improved post treatment . CONCLUSION Larger population studies in the context of high quality , r and omized clinical trial are needed to vali date the results Background Low back pain is a relevant public health problem , being an important cause of work absenteeism worldwide , as well as affecting the quality of life of sufferers and their individual functional performances . Supervised active physical routines and of cognitive-behavioral therapies are recommended for the treatment of chronic Low back pain , although evidence to support the effectiveness of different techniques is missing . Accordingly , the aim of this study is to contrast the effectiveness of two types of exercises , grade d activity or supervised , in decreasing symptoms of chronic low back pain . Methods / design Sample will consist of 66 patients , blindly allocated into one of two groups : 1 ) Grade d activity which , based on an operant approach , will use time-contingent methods aim ing to increase participants ’ activity levels ; 2 ) Supervised exercise , where participants will be trained for strengthening , stretching , and motor control targeting different muscle groups . Interventions will last one hour , and will happen twice a week for 6 weeks . Outcomes ( pain , disability , quality of life , global perceived effect , return to work , physical activity , physical capacity , and kinesiophobia ) will be assessed at baseline , at treatment end , and three and six months after treatment end . Data collection will be conducted by an investigator blinded to treatment allocation . Discussion This project describes the r and omisation method that will be used to compare the effectiveness of two different treatments for chronic low back pain : grade d activity and supervised exercises . Since optimal approach for patients with chronic back pain have yet not been defined based on evidence , good quality studies on the subject are necessary . Trial registration Background Evidence -based clinical practice guidelines may improve treatment quality , but the uptake of guideline recommendations is often incomplete and slow . Recently new low back pain guidelines are being launched in Denmark . The guidelines are considered to reduce personal and public costs . The aim of this study is to evaluate whether a complex , multifaceted implementation strategy of the low back pain guidelines will reduce secondary care referral and improve patient outcomes compared to the usual simple implementation strategy . Methods / design In a two-armed cluster r and omised trial , 100 general practice s ( clusters ) and 2,700 patients aged 18 to 65 years from the North Denmark region will be included . Practice s are r and omly allocated 1:1 to a simple or a complex implementation strategy . Intervention practice s will receive a complex implementation strategy , including guideline facilitator visits , stratification tools , and quality reports on low back pain treatment . Primary outcome is referral to secondary care . Secondary outcomes are pain , physical function , health-related quality of life , patient satisfaction with care and treatment outcome , employment status , and sick leave . Primary and secondary outcomes pertain to the patient level . Assessment s of outcomes are blinded and follow the intention-to-treat principle . Additionally , a process assessment will evaluate the degree to which the intervention elements will be delivered as planned , as well as measure changes in beliefs and behaviours among general practitioners and patients . Discussion This study provides knowledge concerning the process and effect of an intervention to implement low back pain guidelines in general practice , and will provide insight on essential elements to include in future implementation strategies in general practice .Trial registration Registered as NCT01699256 on Clinical Trials.gov 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 Study Design . Classification and functional assessment model for nonspecific low back pain ( LBP ) patients and controls on the basis of kinematic analysis parameters . Objective . Develop a logistic regression model using kinematic analysis variables to ( 1 ) discriminate between LBP patients and controls and ( 2 ) obtain objective parameters for LBP functional assessment . Summary of Background Data . Functional assessment of spinal disorders has been carried out traditionally by means of subjective scales . Objective functional techniques have been developed , which usually involve the application of external loads or the analysis of highly st and ardized trunk flexion-extension maneuvers . Few studies have used everyday activities such as sit-to-st and or lifting an object from the ground . They have shown that the motion patterns of LBP patients differ from those of healthy subjects . Nevertheless , very few studies have tried to correlate objective findings to the results of subjective scales , and no previous study has developed a LBP classification and functional assessment model on the basis of kinematic analysis of everyday activities . Methods . Sixteen controls and 39 LBP patients performed a sit-to-st and task , and lifted three different weights from a st and ing position . The vertical forces exerted and the relative positions of the lower limb and the cervical , thoracic , lumbar , and sacroiliac regions were recorded . Reliability was determined from repetitions of the tests performed by the control group . Binary logistic regression analyses were computed . The results of the selected regression equation were correlated to the Oswestry Disability Index scale results , to check the validity of the procedure for the measurement of functional disability . Results . Reliability of the parameters was good . The selected regression model used two variables , and correctly classified 97.3 % of the patients . High correlations were found between the results of this regression equation and the Oswestry Disability Index scale . Conclusion . It is possible to distinguish LBP patients from healthy subjects by means of the biomechanical analysis of everyday tasks . This kind of analysis can produce objective and reliable indexes about the patients ' degree of functional impairment 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 The Spinal Cord Injury Rehabilitation Evidence ( SCIRE ) is a synthesis of the research evidence underlying rehabilitation interventions to improve the health of people living with SCI . SCIRE covers a comprehensive set of topics and in this issue we present six papers relevant to SCI rehabilitation clinicians ( SCI inpatient rehabilitation practice s , gait strategies , upper extremity reconstructive surgery , spasticity treatments , cardiovascular health and bone health ) . The SCIRE used a systematic and well-defined protocol to assess and synthesize the evidence . Each article was scored for its method ological quality using either the Physiotherapy Evidence Data base ( PEDro ) Score for r and omized controlled trials or the Downs and Black Tool for other types of studies . Following the individual study assessment , conclusions were drawn about the accumulated studies for each topic of interest based on the levels of evidence , quality of studies and concurring evidence . The SCIRE project was design ed for health professionals to inform them of best practice Background Low back pain ( LBP ) is one of the most prevalent and expensive health care problems in industrialised countries . LBP leads to high health care utility and productivity losses ; leaving the individual , the employer , and society with substantial costs . To improve the care for LBP patients and reduce the high societal and financial burden of LBP , in 2010 the ‘ Multidisciplinary care guideline for nonspecific low back pain ’ was developed in the Netherl and s. The current paper describes the design of a study aim ing to evaluate the ( cost- ) effectiveness of a multifaceted strategy to implement this guideline . Methods In a cluster-r and omised controlled trial , the ( cost- ) effectiveness of a multifaceted implementation strategy will be compared to passive guideline dissemination . Using a stepped-wedge approach , participating general practitioners , physiotherapists , and occupational physicians are allocated into clusters and will attend a multidisciplinary continuing medical education training session . The timing these clusters receive the training is the unit of r and omisation . LBP patients visiting the participating health care providers are invited to participate in the trial and will receive access to a multimedia intervention aim ed at improving beliefs , cognitions , and self-management . The primary outcome measure of this study is patient back beliefs . Secondary outcome measures on patient level include pain , functional status , quality of life , health care utility , and productivity losses . Outcome measures on professional level include knowledge and attitude towards the guideline , and guideline adherence . A process evaluation for the implementation strategy will be performed among the health care providers and the patients . Furthermore , a qualitative subgroup analysis among patients with various ethnic background s will be performed . Discussion This study will give insight into the ( cost- ) effectiveness of a multifaceted implementation strategy for the Dutch multidisciplinary guideline for non-specific back pain to improve outcomes on patient and professional level . The valuable information gained with this study may prove useful for policy-makers , health care providers , and research ers who are in the process of reducing the burden of back pain on individuals and society . Trial Registration Netherl and s Trial Register ( NTR ) : NTR4329 . Registered December 20th , 2013 OBJECTIVE < < Back School > > has been used as a way of preventing and treating back pain since 1969 , but reports in the literature on its effectiveness remain controversial . The purpose of this trial was to evaluate efficacy of a back school program for non- -specific chronic low-back pain . PATIENTS AND METHODS Seventy patients were r and omized into two groups : experimental group ( 34 patients ) and control group ( 36 patients ) . Experimental group patients participated in a theoretical and practical back school program , which was composed of 4 weekly classes of 60 minutes .  Control group patients  were allocated at a waiting list . Three evaluations took place ( baseline , after 4 and 16 weeks ) . The following variables were analyzed : pain intensity ( visual numeric analogue scale ) , functional disability ( Rol and -Morris Disability Question naire ) and spinal mobility ( Schöber index ) . Statistical analysis for intra-group and inter-group used significance level of p < 0.05 . RESULTS 57 patients were analyzed ( 29 in experimental group and 28 in control group ) . A statistically significant improvement was observed only in the experimental group , regarding pain intensity , functional disability and spine mobility . Such improvements have persisted after 16 weeks in pain intensity and functional disability variables . In the inter-group analysis we observed a statistically significant difference in the second and third evaluations concerning the functional disability variables and spinal mobility . CONCLUSION The Back School program proposed in this study seems to be effective for non-specific chronic low back pain Study Design . Clinical practice guideline . Objective . To develop evidence -based recommendations on use of interventional diagnostic tests and therapies , surgeries , and interdisciplinary rehabilitation for low back pain of any duration , with or without leg pain . Summary of Background Data . Management of patients with persistent and disabling low back pain remains a clinical challenge . A number of interventional diagnostic tests and therapies and surgery are available and their use is increasing , but in some cases their utility remains uncertain or controversial . Interdisciplinary rehabilitation has also been proposed as a potentially effective noninvasive intervention for persistent and disabling low back pain . Methods . A multidisciplinary panel was convened by the American Pain Society . Its recommendations were based on a systematic review that focused on evidence from r and omized controlled trials . Recommendations were grade d using methods adapted from the US Preventive Services Task Force and the Grading of Recommendations , Assessment , Development , and Evaluation Working Group . Results . Investigators review ed 3348 abstract s. A total of 161 r and omized trials were deemed relevant to the recommendations in this guideline . The panel developed a total of 8 recommendations . Conclusion . Recommendations on use of interventional diagnostic tests and therapies , surgery , and interdisciplinary rehabilitation are presented . Due to important trade-offs between potential benefits , harms , costs , and burdens of alternative therapies , shared decision-making is an important component of a number of the recommendations Chronic low back pain ( CLBP ) is associated with persistent or recurrent disability which results in high costs for society . Cognitive behavioral treatments produce clinical ly relevant benefits for patients with CLBP . Nevertheless , no clear evidence for the most appropriate intervention is yet available . The purpose of this study is to evaluate the mid-term effects of treatment in a cohort of patients with CLBP participating in an intensive pain management programme . The programme provided by RealHealth-Netherl and s is based on cognitive behavioral principles and executed in collaboration with orthopedic surgeons . Main outcome parameters were daily functioning ( Rol and and Morris Disability Question naire and Oswestry Disability Question naire ) , self-efficacy ( Pain Self-Efficacy Question naire ) and quality of life ( Short Form 36 Physical Component Score ) . All parameters were measured at baseline , last day of residential programme and at 1 and 12 months follow-up . Repeated measures analysis was applied to examine changes over time . Clinical relevance was examined using minimal clinical important differences ( MCID ) estimates for main outcomes . To compare results with literature effect sizes ( Cohen ’s d ) and St and ardized Morbidity Ratios ( SMR ) were determined . 107 patients with CLBP participated in this programme .  Mean scores on outcome measures showed a similar pattern : improvement after residential programme and maintenance of results over time . Effect sizes were 0.9 for functioning , 0.8 for self-efficacy and 1.3 for physical functioning related quality of life . Clinical relevancy : 79 % reached MCID on functioning , 53 % on self-efficacy and 80 % on quality of life . Study results on functioning were found to be 36 % better and 2 % worse when related to previous research on , respectively , rehabilitation programmes and spinal surgery for similar conditions ( SMR 136 and 98 % , respectively ) . The participants of this evidence -based programme learned to manage CLBP , improved in daily functioning and quality of life . The study results are meaningful and comparable with results of spinal surgery and even better than results from less intensive rehabilitation programmes There are strong arguments for publishing research protocol s before the results are available . First , it permits a critical judgment of the design unbiased by knowledge of the results , and second it may prevent publication bias . We present the design of a r and omized trial on the effectiveness of manual therapy , physiotherapy , ( continued ) treatment by the general practitioner and a placebo treatment for patients ( n = 300 ) with chronic ( more than 6 wk ) nonspecific back and neck complaints . In design ing this trial in close cooperation with manual therapists and physiotherapists , special attention has been given to inclusion and exclusion criteria , ( blinded ) outcome measurements and control ( placebo ) treatment(s ) . Outcome measures include severity of complaints rated by a blinded research assistant , global perceived effect assessed by the patient , pain severity , functional status , range of motion ( ROM ) of the spine and recurrence . Measurements are carried out at baseline and after 3 wk , 6 wk , 3 months , 6 months and 1 yr Background Few data are available on the course of and predictors for disability in patients with chronic nonspecific low back pain ( CNSLBP ) . Objective The purpose of this study was to describe the course of disability and identify clinical ly important prognostic factors of low-back-pain – specific disability in patients with CNSLBP receiving multidisciplinary therapy .  Design A prospect i ve cohort study was conducted . Methods A total of 1,760 patients with CNSLBP who received multidisciplinary therapy  were evaluated for their course of disability and prognostic factors at baseline and at 2- , 5- , and 12-month follow-ups . Recovery was defined as 30 % reduction in low back pain – specific disability at follow-up compared with baseline and as absolute recovery if the score on the Quebec Back Pain Disability Scale ( QBPDS ) was ≤20 points at follow-up . Potential prognostic factors were identified using multivariable logistic regression analysis . Results Mean patient-reported disability scores on the QBPDS ranged from 51.7 ( SD=15.6 ) at baseline to 31.7 ( SD=15.2 ) , 31.1 ( SD=18.2 ) , and 29.1 ( SD=20.0 ) at 2 , 5 , and 12 months , respectively . The prognostic factors identified for recovery at 5 and 12 months were younger age and high scores on disability and on the 36-Item Short-Form Health Survey ( SF-36 ) ( Physical and Mental Component Summaries ) at baseline . In addition , at 5-month follow-up , a shorter duration of complaints was a positive predictor , and having no comorbidity and less pain at baseline were additional predictors at 12-month follow-up . Limitations Missing values at 5- and 12-month follow-ups were 11.1 % and 45.2 % , respectively . Conclusion After multidisciplinary treatment , the course of disability in patients with CNSLBP continued to decline over a 12-month period . At 5- and 12-month follow-ups , prognostic factors were identified for a clinical ly relevant decrease in disability scores on the QBPDS OBJECTIVES The purpose of this study was to compare the outcomes of patients with low back pain who had a matched , unmatched , or were indifferent with their pretreatment expectation/preference to the manual therapy thrust or nonthrust intervention .  A secondary purpose was to explore baseline patient characteristics affiliated with a preference of manual therapy treatment type ( thrust or nonthrust manipulation ) . METHODS The study is a secondary analysis of a prospect i ve r and omized controlled trial that enrolled 149 patients with low back pain , from 16 distinct outpatient physical therapy practice s within the United States . Patient 's pretreatment expectations were identified before r and omization . The intervention included manual therapy ( thrust or nonthrust manipulation ) with a st and ardized exercise program , which was carried out for 2 treatment sessions . Six outcomes captured the constructs of ( a ) disability , ( b ) pain perception , ( c ) care intensity , ( d ) fear avoidance behaviors , and ( e ) perception of extent of recovery . Descriptive statistics , analysis of variance ( and Tukey , a post hoc test ) , Fisher exact test , and a multivariate logistic regression analysis were used for analysis . RESULTS There were no statistical differences in any of the 6 dedicated outcomes measures between the matched , unmatched , and no preference groups . Therapist-determined patient " irritability " was associated with patient preference of nonthrust treatment , and higher body mass index was associated with patient preference of thrust treatment . CONCLUSIONS This study shows that patients demonstrated no statistical difference in disability or pain outcome measures when matched , unmatched , or indifferent to the intervention Background Evidence generated from reliable research is not frequently implemented into clinical practice . Evidence -based clinical practice guidelines are a potential vehicle to achieve this . A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines . Recommendations from this review , and other studies , have suggested the use of interventions that are theoretically based because these may be more effective than those that are not . An evidence -based clinical practice guideline for the management of acute low back pain was recently developed in Australia . This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common , has a high burden , and for which there is an evidence - practice gap in the primary care setting . Aim This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria , Australia . Specifically , our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray  , and improving mean level of disability for patients three months post-consultation . Methods / Design This study protocol describes the details of a cluster r and omised controlled trial . Ninety-two general practice s ( clusters ) , which include at least one consenting general practitioner , will be r and omised to an intervention or control arm using restricted r and omisation . Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion . An average of twenty-five patients per general practice will be recruited , providing a total of 2,300 patient participants . General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy . Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory . Investigators ( not involved in the delivery of the intervention ) , patients , outcome assessors and the study statistician will be blinded to group allocation . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN012606000098538 ( date registered 14/03/2006 )
We found conflicting data regarding the validity of methods used to examine back muscle fatigue .
The Biering-Sorensen test  , performed in conjunction with surface electromyography spectral analysis , turned out to be the most widely used and comparatively , the most optimal modality currently available to assess objective back muscle fatigue in daily clinical practise , even though critical limitations are discussed .
Implication s for Rehabilitation Despite its limitations , the Biering-Sorensen test is currently the most used , convenient and easily available fatiguing test for lumbar muscles .
Pooled mean frequency and half-width of the spectrum are currently the most valid electromyographic parameters to assess fatigue in chronic non-specific low back pain .
PURPOSE This systematic literature review aim ed at examining the validity and applicability in everyday clinical rehabilitation practise of methods for the assessment of back muscle fatiguability in patients with chronic non-specific low back pain ( CNSLBP ) .