Back Pain: Aquatic Exercises and Education

Aquatic exercises and pain neurophysiology education vs. aquatic exercises alone for patients with chronic low back pain: a randomized controlled trial.

By Pires D, Polytechnic Institute of Castelo Branco – Physiotherapy Department, School of Health Care, Castelo Branco, Portugal; Cruz EB and Caeiro C. from the Polytechnic Institute of Setúbal – Physiotherapy Department, School of Health Care, Setúbal, Portugal, Jun 2015



The aim of this study was to compare the effectiveness of a combination of aquatic exercises and pain neurophysiology education with aquatic exercises alone in chronic low back pain patients.



Single-blind randomized controlled trial.



Outpatient clinic.



Sixty-two chronic low back pain patients were randomly allocated to receive aquatic exercises and pain neurophysiology education (n = 30) or aquatic exercises alone (n = 32).



Twelve sessions of a 6-week aquatic exercises programme preceded by 2 sessions of pain neurophysiology education. Controls received only 12 sessions of the 6-week aquatic exercises programme.



The primary outcomes were pain intensity (Visual Analogue Scale) and functional disability (Quebec Back Pain Disability Scale) at the baseline, 6 weeks after the beginning of the aquatic exercises programme and at the 3 months follow-up. Secondary outcome was kinesiophobia (Tampa Scale of Kinesiophobia).



Fifty-five participants completed the study. Analysis using mixed-model ANOVA revealed a significant treatment condition interaction on pain intensity at the 3 months follow-up, favouring the education group (mean SD change: -25.4± 26.7 vs -6.6 ± 30.7, P < 0.005). Although participants in the education group were more likely to report perceived functional benefits from treatment at 3 months follow-up (RR=1.63, 95%CI: 1.01-2.63), no significant differences were found in functional disability and kinesiophobia between groups at any time.



This study’s findings support the provision of pain neurophysiology education as a clinically effective addition to aquatic exercises.


SAGE Publications – Clinical Rehabilitation – June 2015 vol. 29 no. 6 538-547

PMID: 25200879