The aim of this study is to compare SMCE and general exercises within the sub-group of patients with MD in the sub-acute stage of LBP. The main study question is which of the two exercise programs is more effective in reducing the disability associated with LBP.
European clinical guideline for management of chronic LBP recommends that more research is required to develop tools to improve the classification and identification of specific clinical sub-groups of chronic LBP patients [5
]. Good quality RCTs are then needed to determine the effectiveness of specific interventions aimed at these specific risk/target groups. There is a need to evaluate sub-acute non-specific LBP and need to study interventions aimed at subgroup of patients with MD.
This RCT aims to test the hypothesis whether patients within a sub-group of MD benefit more through a specific individually tailored exercise program than through general exercise.
The participants in this trial are unique population; a sub-classification of MD or movement control impairment in non-specific LBP patients will show that the findings of this trial can confidently be applied to similar populations. The comparison is between two exercise programs and therefore the data should not be used to make inferences about the effectiveness, compared to no intervention, of any of the treatments. The findings can assist care providers, therapists and people with sub-acute LBP to make rational decisions about treatment. Care providers will need to take into account how the interventions are administered.
The study protocol of investigating patients with sub-acute LBP is important. If there are effective ways of preventing LBP to become chronic, the high costs of treating patients could be avoided.
This study has several limitations. The treating physiotherapist or subjects cannot be blinded, however because there is no accepted standard therapy, it is not truly known which therapy is better. The amount of the home exercises is totally dependent the motivation of the subject to perform the given exercise program which could influence the outcome of this study. Core stability represents a spectrum of exercises [64
]. The comparison group includes a group of core stability exercises, core stiffness exercises, that involves an element of control of the spine. This means that both groups have an intervention that is cognitively attempting to control the position of the spine, although they also have fundamental differences in their application and potential benefits. This study includes subjects with recurrent, sub-acute LBP. Some of these individuals may spontaneously recover [4
]. With a small sample size, the results would have to be interpreted with caution. There are several aspects of the study which influence the external validity. The application of the interventions within the study relies on the skills of the treating physiotherapist. Physiotherapists could learn to teach general exercise program, but the assessment and rehabilitation of MD is not taught in all undergraduate courses and post graduate training is required. This study will use five treatment sessions, however it may take longer for some patients to learn the SMCE well enough to change the movement patterns and decrease disability. In practice, greater than five sessions is likely possible, however if the SMCE are not effective in reducing disability, it is not known what would happen with a longer rehabilitation time frame with more sessions. In clinical practice, time and costs often limit the time that a physiotherapist can spend with a patient. It may not be appropriate to physiotherapists to spend forty-five minutes with patients as was done in this study. This could influence the application of learning the SMCE.
The main study question is which of the two exercise programs is more effective in reducing the disability associated with LBP.