Effects of an active kinesitherapy exercise program adapted to chronic low back pain patients: Single group quasi-experimental pre-post design study

The review of scientific literature on physical exercise in the treatment of chronic low back pain indicates that exercise programs can be a therapeutic option for reducing disability. Kinesiotherapy could be effective in the long term, especially when integrated into programs tailored to low back pain. However, research results are often unsatisfactory because they do not address the most relevant clinical issues for primary and secondary care professionals dealing with daily low back pain. These unexplored priorities leave a gap in clinical practice, hindering the effective implementation of evidence-based treatments. Objective: To evaluate the efficacy of adapted active kinesiotherapy in the treatment of chronic low back pain, analyzing improvement in disability considering both minimally clinically significant differences and minimally clinically important differences and determining the proportion of patients experiencing clinically relevant improvements or deteriorations. Methodology: A prospective longitudinal study was conducted with a pre- and post-intervention physical rehabilitation assessment at the University Hospital of Henares (Coslada, Spain). The sample consisted of 30 patients, of whom 24 completed the study and 6 did not attend sessions. The mean age of the participants was 57.33 years, 75% were women, and the average body mass index was 25.78. The rehabilitation program consisted of adapted active kinesiotherapy exercises for low back pain, carried out over three months, with two 60-minute sessions per week. To analyze differences in disability levels before and after treatment, assessed with the Roland Morris questionnaire, paired t-tests were performed. Statistical differences were determined for the total sample and subgroups according to percentage improvement ranges. Improvements were classified as "much better" (>= 30%), "noticeably better" (25-29%), and "somewhat better" (15-24%). A scatterplot and linear regression were used to model the relationship between "% improvement" and "score difference," determining thresholds for clinical changes. Results and conclusions: The 1.67-point improvement in the Roland Morris score indicates a clinically significant impact. However, the average improvement for the entire sample was 17%, indicating an early but not significant clinical improvement. 37.5% of patients did not experience clinically significant improvements (67% of them with low levels of pre-treatment disability). However, 82.5% of patients showed clinically relevant improvements: 12.5% with "somewhat better" improvements and 50% with "much better" improvements. According to the study's linear regression, a difference of 3.11 points indicates "much better" improvements and 1.42 points indicates "somewhat better" improvements.