European Spine Journal

, Volume 18, Issue 12, pp 1881–1891 | Cite as

Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome

  • Anne F. MannionEmail author
  • Daniel Helbling
  • Natascha Pulkovski
  • Haiko Sprott
Original Article


Exercise rehabilitation is one of the few evidence-based treatments for chronic non-specific low back pain (cLBP), but individual success is notoriously variable and may depend on the patient’s adherence to the prescribed exercise regime. This prospective study examined factors associated with adherence and the relationship between adherence and outcome after a programme of physiotherapeutic spine stabilisation exercises. A total of 32/37 patients with cLBP completed the study (mean age, 44.0 (SD = 12.3) years; 11/32 (34%) male). Adherence to the 9-week programme was documented as: percent attendance at therapy, percent adherence to daily home exercises (patient diary) and percent commitment to rehabilitation (Sports Injury Rehabilitation Adherence Scale (SIRAS)). The average of these three measures formed a multidimensional adherence index (MAI). Psychological disturbance, fear-avoidance beliefs, catastrophising, exercise self-efficacy and health locus of control were measured by questionnaire; disability in everyday activities was scored with the Roland–Morris disability scale and back pain intensity with a 0–10 graphic rating scale. Overall, adherence to therapy was very good (average MAI score, 85%; median (IQR), 89 (15)%). The only psychological/beliefs variable showing a unique significant association with MAI was exercise self-efficacy (Rho = 0.36, P = 0.045). Pain intensity and self-rated disability decreased significantly after therapy (each P < 0.01). Adherence to home exercises showed a moderate, positive correlation with the reduction in average pain (Rho = 0.54, P = 0.003) and disability (Rho = 0.38, P = 0.036); higher MAI scores were associated with greater reductions in average pain (Rho = 0.48, P = 0.008) and a (n.s.) tendency for greater reductions in disability (Rho = 0.32, P = 0.07) Neither attendance at therapy nor SIRAS were significantly related to any of the outcomes. The benefits of rehabilitation depended to a large extent on the patient’s exercise behaviour outside of the formal physiotherapy sessions. Hence, more effort should be invested in finding ways to improve patients’ motivation to take responsibility for the success of their own therapy, perhaps by increasing exercise self-efficacy. Whether the “adherence–outcome” interaction was mediated by improvements in function related to the specific exercises, or by a more “global” effect of the programme, remains to be examined.


Chronic low back pain Exercise rehabilitation Spinal segmental stabilisation exercises Outcome Adherence 



This study was supported by a grant from the Swiss National Research Program NRP 53 “Musculoskeletal Health–Chronic Pain” of the Swiss National Science Foundation (Project 405340-104787/2) and the Schulthess Klinik Research Funds. We would like to express our thanks to: Prof Beat A. Michel for providing the infrastructure to carry out this work within the Department of Rheumatology and Institute of Physical Medicine, University Hospital Zürich, Switzerland; Filomena Caporaso, Deborah Gubler and Valeriu Toma for their assistance with the data collection; the physiotherapists Martin Litschi, Tamar Bon, Konstanze Wagner, Elfi Raffainer, Luca Scascighini, Raymond Denzler, Wiebke Schubien, Manuela Meier, Melanie Knecht, Selina Bühler, Christina Gruber and Diana Brun-Walser for treating the patients and completing the necessary documentation; Doctors Bischoff, Camenzind, Distler, Haltinner, Klipstein, Rörig, Schmidt, Sprott, Stärkle-Bär, Tamborrini, Thoma, Zimmermann (USZ), Bartanusz, Kramers-de Quervain, Marx, Pihan (Schulthess Klinik), Brunner (Balgrist), Kern, Kurmann, Schuler, Stössel and Zoller (GP practices) for referring patients to the study; all the patients who took part in the study; and Britton Brewer for his advice with regard to the adherence measures.


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Anne F. Mannion
    • 1
    Email author
  • Daniel Helbling
    • 2
  • Natascha Pulkovski
    • 2
  • Haiko Sprott
    • 2
  1. 1.Spine Center Division, Department of Research and DevelopmentSchulthess KlinikZurichSwitzerland
  2. 2.Department of Rheumatology and Institute of Physical MedicineUniversity Hospital ZürichZurichSwitzerland

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