A critical appraisal of "Combined Exercise and Motivation Program: Effect on the Compliance and Level of Disability of Patients with Chronic Low Back Pain: A Randomized Controlled Trial"
Researchers and clinicians agree that therapeutic exercise is a critical tool in decreasing pain and disability. It is particularly difficult however, to motivate patients to complete an exercise treatment program even if they know that it is the best course to reducing pain and disability levels. The study to be appraised focused on specific ways to increase patients' motivation and compliance and if this affected their pain and disability. This article was greatly strengthened by its design and sample size. The 93-subject, prospective, double-blind, RCT made it possible for the results of the article to be easily applicable in any clinic. The authors were well-read on previous relevant material and cited primary sources from reputable journals made some particularly interesting points about teaching patients about their "internal locus of control". However, the article was weakened by in the treatment group, some "tailoring" of the exercise programs was allowed, which may have led to different treatments between groups. Most of the outcome measures used are subjective questionnaires answered by the patients, which may have introduced a significant amount of bias. Also, the authors neglected to explain the clinical significance of these outcome measures. There was no attempt to give a MCID or NNT that would have helped the reader be more informed about the significance of this article's findings.