General group exercise in low back pain management in a military population, a comparison with specific spine group exercise: a service evaluation

Objective To investigate whether general group exercise (GGE) offers the same outcomes compared with a specific spinal group exercise (SSGE) for chronic low back pain (CLBP) in a military population. Design Retrospective service evaluation using routine service activity data. Setting A UK military rehabilitation centre. Participants A total of 106 patients with CLBP. Interventions Three-week intensive (5 days per week, 15-day intervention) rehabilitation course for patients with CLBP. Six SSGE groups (n=64); CLBP only. Six GGE groups (n=42); CLBP patients grouped with chronic lower limb (LL) injuries. Outcome measures Oswestry Disability Index (ODI), Numerical Pain-Rating Scores and the Modified Multi-Stage Fitness Test (Mod-MSFT). Long-term effects were measured by Medical Employment Standard (MES) status and physiotherapy follow-up at 3 and 12 months. Results A between-group analysis showed no significant difference in GGE compared with SSGE. Mean changes (SD) in pain were -2.71 +/- 2.35 and -1.20 +/- 1.99 (p=0.018), ODI were -3.6 +/- 5.7 and -4 +/- 8.5 respectively (p=0.649) and Mod-MSFT 28.4 +/- 30.8 and 29.7 +/- 31.7 respectively (p=0.792). At 3 months, a greater proportion of the GGE were having ongoing physiotherapy; GGE=50%, SSGE=30.2%, (p=0.016) although some differences were evident across MES with 32.5 % of GGE compared with 20.6 % of SSGE being medically fit with no restrictions. At 12 months, groups were largely comparable for follow-up physiotherapy and MES; 22.5% of GGE and 20.6% of SSGE continued to have physiotherapy input; 47.5% of GGE and 50.8% of SSGE were medically fit with no restrictions. Conclusion Patients with CLBP who completed a 3-week rehabilitation programme had comparable outcomes when grouped with patients with LL, although only improvements in pain in the GGE group achieved a meaningful change. Further evaluation of potential costs and savings to service costs is now required.