[Evaluation after four years of exercise therapy for chronic low back pain]

To assess at four years follow-up the efficiency of exercise therapy for chronic low back pain in terms of pain, physical ability, quality of life and return to work.

Patients who graduated from a functional restoration program between April 1997 and June 1999, answered a questionnaire at one year follow-up. The patients who had answered this questionnaire were evaluated 48 months later: they first answered another questionnaire and then most underwent a clinical examination assessing pain on a visual analogue scale, flexibility by use of the Schöber index and the finger-ground distance test, endurance of abdominal and spinal muscles, and quality of life as assessed by the Dallas pain questionnaire.

Thirty-four patients graduated from the program; 26 were studied at four-year follow-up. Pain intensity was significantly reduced. Improvement in flexibility after the program remained at four-year follow-up, whereas improvement in endurance did not. Scores on the Dallas pain questionnaire remained as improved as those at one-year follow-up. Initially, 23 of the 26 patients had a job; 19 were on sick leave for an average of 35 weeks. At four-year follow-up, 16 patients were still working, and 56% had changed jobs. Six patients pursued a regular activity before entering the program; at four-year follow-up, 17 were regularly active. No significant relationship was found between the pursuit of physical activity and return to work. Nevertheless, a significant relationship was found between having a regular physical activity and improvement of the finger-ground distance and endurance of spinal muscles. This observation was not true for the Dallas pain questionnaire scores.

Despite the lack of a control group, this study seems to favour a benefit in the functional restoration program.