Physiotherapist-led exercise classes for low back pain show changes in disability and fear of movement: a service evaluation

Objective: This evaluation aimed to examine the effects of physiotherapist-led back classes in a health care setting on measures of disability and pain-related fear of movement. Design: A service evaluation of pre- and post-class outcome measures with additional follow-up at 6 months and 1 year.Participants: 447 participants (299 women) with low back pain [LBP] (with or without leg pain).Interventions: Six sessions, one hour per week, of ‘Back to Fitness’ physiotherapist-led exercise classes for LBP based on a biopsychosocial approach.Outcome Measures: Roland Morris Disability Questionnaire (RMDQ) and the Tampa Scale of Kinesiophobia 13 (TSK-13).Results: Of the 447 participants, 210 participants completed baseline and week 6 outcome measures (47%). 218 were sent 6 month follow up questionnaires and 59 responded (27%). The 59 responders from the 6 month follow up were sent 1year follow up questionnaires to which 21 responded (36%). Significant and clinically relevant reductions in RMDQ were seen immediately post class. Further reductions were seen at 6 months and 12 months with a 50% [2.3 points, p<0.05] reduction in mean RMDQ score at 1 year. TSK-13 scores significantly reduced in a similar pattern though the results at one year were not statistically significant.Conclusions: ‘Back to Fitness’ physiotherapist-led exercise classes can reduce disability and pain-related fear of movement in patients with LBP. Reductions in disability were maintained for up to one year. Given the non-controlled nature of this evaluation we cannot attribute cause and effect. The large dropout rate also warrants caution when interpreting these results. However, these findings suggest that the effects of group exercise classes reported in the literature can be reasonably generalised to the modern day real world NHS setting.