Effects of a 14-Week Rehabilitation Program Based on a Customized Multimodal Protocol in Individuals with Chronic Non-Specific LBP
Keywords:
Chronic non - specific low back pain, physical therapy, Aquatic movements, Flexion based exercises, Extension oriented exercises, Rehabilitation.Abstract
Objective: To evaluate the effectiveness of a 14-week multimodal rehabilitation program compared with flexion-based and extension-oriented exercise protocols on pain-related disability and lumbar range of motion in adults with chronic non-specific low back pain.
Methods and Materials: In a single-center, assessor-blinded, parallel-group randomized controlled trial, 180 adults with CLBP (≥4 months; 45–72 years) were allocated (n=60/group) to: (1) multimodal comprehensive program (specialized therapeutic exercise + aquatic movements + physiotherapy modalities + massage; 90–100 min/session, 3×/week), (2) flexion-based protocol (45–60 min/session, 3×/week), or (3) extension-oriented protocol (45–60 min/session, 3×/week). Outcomes were assessed at baseline, post-intervention, and 1-month follow-up. Primary outcome was disability/pain impact using the Quebec Back Pain Disability Scale (QBPDS). Lumbar range of motion (LROM) was measured via field tests (trunk flexion, lateral flexion right/left, and supine hip/knee flexion). Analyses used repeated-measures MANOVA/ANOVA (time×group), Tukey post-hoc tests, and paired t-tests (α≤0.05).
Findings: QBPDS improved within all groups (Group 1: t=15.705, p=0.001; Group 2: t=9.410, p=0.001; Group 3: t=6.930, p=0.001). Group 1 showed the greatest reduction (54.70→16.10; follow-up 21.20) versus Group 2 (53.12→29.12; follow-up 40.80) and Group 3 (55.70→31.70; follow-up 42.10), with between-group differences favoring Group 1 (Tukey p≤0.01). LROM improved significantly in Group 1 across all tests (e.g., trunk flexion t=7.771, p=0.001) and in Group 2 (all p=0.001), while Group 3 showed no trunk-flexion change (t=1.302, p=0.216). Gender effects were non-significant (p>0.05).
Conclusion: A 14-week customized multimodal rehabilitation program produced greater and more sustained improvements in disability/pain and lumbar mobility than either flexion-based or extension-oriented exercise alone in adults with chronic non-specific LBP.
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References
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