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Prof. Dr. Klaus Pfeifer

Institut für Sportwissenschaft und Sport, FAU


Gebbertstraße 123b

91058 Erlangen

T. 09131-8528106

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Behaviour-based exercise therapy for the optimisation of behavioural-medical-orthopaedic rehabilitation in chronic back pain

Background. Behavioural-medical-orthopaedic rehabilitation (BMO) is effective in the short term in the treatment of chronic back pain. A central treatment component consists of exercise therapeutic interventions to improve physical fitness. Potential for development exists in exercise therapeutic interventions in a targeted integration of behaviour-based aspects such as the imparting of self-management competencies in dealing with back pain and strategies for building up a long-term commitment to physical activity. A differentiated processing of the mechanisms of action of exercise therapeutic interventions is still lacking with regard to a successful and sustainable BMO.


Study design. Multi-centre prospective controlled and randomised longitudinal study with four measurement time points (beginning of rehab, end of rehab, 6- and 12-month follow-up).


Objective. The project will include a) the multi-centre implementation of a standardised behaviour-based exercise therapy in an existing BMO for persons with chronic back pain and b) the evaluation of specific effects of the optimised exercise therapy in the BMO compared to the usual procedure in BMO.


Setting. Two inpatient rehabilitation establishments with a behavioural-medical-orthopaedic treatment concept for the therapy of chronic back pain.


Target group. 214 rehabilitees with chronic unspecified back pain with main diagnoses M54.4 – M54.9; M51.2 – M51.9; M53.8 - M53.9 according to ICD-10.


Target parameters. The primary target criterion is the subjective functional impairment one year after rehabilitation. Secondary parameters are pain-related cognitions, pain management, back pain, physical activity and subjective health/quality of life.


Methodological procedure. The preparation phase (three months, phase 1, milestone 1) contains the organisation of the program implementation, the development of the intensive training for the exercise therapists, methodological preparations as well as the adaptation of structures and processes to the recruitment and randomisation of the participants. In the subsequent implementation phase, the behaviour-based exercise therapy will be introduced and tested. For purposes of quality assurance, the implementation process will be evaluated in a process-relevant manner using qualitative and quantitative procedures (four months, phase II, milestone II). Subsequently, in the intervention phase, the rehabilitees will be randomly allocated to a) the usual BMO as a control condition (CG) and b) the BMO with an optimised behaviour-based exercise therapy as the intervention condition (IG): The participants who are treated in the clinics during this period and are willing to take part will be surveyed at the beginning and end of the rehabilitation (12 months, phase III, milestone III). In order to measure the medium and long-term effects of the interventions conducted in the control and intervention group, in the follow-up phase, the 6- and 12-month follow-up will be examined. Finally, the data will be analysed and evaluated (17 months, phase IV, milestones IV and V).


Utilisation of results. Research results will be disseminated in national and international publications. The concept with corresponding media and materials for therapists and rehabilitees can be implemented for the improvement of inpatient care with chronic back pain in routine care. The developed manuals/handbooks and media can be used as a basis for further therapy training programs and the contents of the evaluated concept can be transferred to training curricula.


Cooperating clinics:

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