{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:24:36Z","timestamp":1789989876254,"version":"4.0.1"},"reference-count":76,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2009,9,19]],"date-time":"2009-09-19T00:00:00Z","timestamp":1253318400000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"German Federal Ministry of Health and Social Security","award":["124-43164-1\/527"],"award-info":[{"award-number":["124-43164-1\/527"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2009,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective of this study was to examine whether a multimodal, secondary prevention program (MP) is superior to a general physical exercise program (EP) in influencing the process leading to chronic low back pain (LBP) in nurses with a history of back pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>The study was conducted as a randomized controlled parallel\u2010group trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The interventions were performed in a single center at the Department of Physical and Rehabilitation Medicine at the University of Munich in Germany.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>A total of 235 nurses from 14 nearby hospitals and nursing homes who experienced at least one episode of back pain during the previous 2 years were invited into the study. Of these, 183 nurses were enrolled and 169 (83 in the MP and 86 in the EP) qualified for the intent\u2010to\u2010treat analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>The EP consisted of 11 group sessions, each lasting 1 hour. After introductory sessions, subsequent sessions included general physical strengthening and stretching exercises as well as instructions for a home\u2010training program. The MP consisted of 17 group sessions of 1.75 hours and one individual session of 45 minutes. In addition to the full EP, the MP included 5 psychological units, 7 segmental stabilization exercises units, and 8 ergonomic and workplace\u2010specific units.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measurements<\/jats:title><jats:p>The primary study end\u2010point variable was pain interference, and the secondary study end\u2010point variables were pain intensity and functioning as measured with the West Haven\u2010Yale Multidimensional Pain Inventory and the Short Form\u201036, respectively. These study end\u2010point variables were defined a priori.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was no statistically significant difference between the 2 groups. Small\u2010to\u2010moderate effects were observed in both intervention programs across all study end\u2010point variables. For pain interference, the effect size at 12 months after intervention was 0.58 in the MP and 0.47 in the EP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A multimodal program is not superior to a general exercise program in influencing the process leading to chronic LBP in a population of nurses with a history of pain. The most likely explanation is a common psychological mechanism leading to improved pain interference that is irrespective of the program used. Considering the lower resources of the general exercise program, the expense for a multimodal program is not justified for the secondary prevention of LBP and disability.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.pmrj.2009.07.006","type":"journal-article","created":{"date-parts":[[2009,9,20]],"date-time":"2009-09-20T08:43:25Z","timestamp":1253436205000},"page":"798-808","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["The Comparative Effectiveness of a Multimodal Program Versus Exercise Alone for the Secondary Prevention of Chronic Low Back Pain and Disability"],"prefix":"10.1002","volume":"1","author":[{"given":"Thomas","family":"Ewert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heribert","family":"Limm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Wessels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berid","family":"Rackwitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"von Garnier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Freumuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerold","family":"Stucki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2009,9,19]]},"reference":[{"key":"e_1_2_7_2_2","volume-title":"WHO Technical Report Series. The burden of musculoskeletal conditions at the start of the new millennium","author":"World Health Organization","year":"2003"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1080\/16501960410016037"},{"key":"e_1_2_7_4_2","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S0304-3959(99)00187-6","article-title":"The economic burden of back pain in the UK","volume":"84","author":"Maniadakis N.","year":"2000","journal-title":"Pain"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002508-200501000-00005"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(97)00106-1"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02765872"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-7-200710020-00006"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1053\/berh.2001.0204"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00043764-199812000-00011"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-004-0749-6"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200104010-00019"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00420-002-0332-6"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2648.1996.13423.x"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000144410.89182.f9"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199910150-00004"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.319.7205.279"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/165019701750300636"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1054\/math.1995.0243"},{"key":"e_1_2_7_20_2","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/B978-0-443-07293-2.50016-9","volume-title":"Therapeutic Exercise for Lumbopelvic Stabilisation","author":"Richardson C.","year":"2004"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/occmed\/kqg109"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1191\/0269215506cr977oa"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0004-9514(06)70043-5"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000203709.65384.9d"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200005010-00017"},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-007-0439-2"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200011010-00017"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1136\/oem.60.10.715"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1136\/oem.57.1.28"},{"key":"e_1_2_7_30_2","first-page":"1213","article-title":"Occupational risk factors for low back pain among sedentary workers","volume":"35","author":"Burdorf A.","year":"1993","journal-title":"J Occup Med"},{"key":"e_1_2_7_31_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1016656225318"},{"key":"e_1_2_7_32_2","doi-asserted-by":"publisher","DOI":"10.1080\/09638280110061744"},{"key":"e_1_2_7_33_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39463.418380.BE"},{"key":"e_1_2_7_34_2","doi-asserted-by":"publisher","DOI":"10.1136\/oem.2006.030643"},{"key":"e_1_2_7_35_2","first-page":"257","article-title":"The effectiveness of back pain and injury prevention programs in the workplace","volume":"20","author":"Gatty C.M.","year":"2003","journal-title":"Work"},{"key":"e_1_2_7_36_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200102010-00011"},{"key":"e_1_2_7_37_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1533-2500.2008.00176.x"},{"key":"e_1_2_7_38_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002508-200411000-00010"},{"key":"e_1_2_7_39_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-007-0433-8"},{"key":"e_1_2_7_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(85)90004-1"},{"key":"e_1_2_7_41_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199206000-00002"},{"key":"e_1_2_7_42_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200404150-00006"},{"key":"e_1_2_7_43_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.284.23.3043"},{"key":"e_1_2_7_44_2","volume-title":"RIPP Rueckenschmerz Intensiv Praeventionsprogramm f\u00fcr den Pflegeberuf. Ein Multimodales Konzept","author":"Limm H.","year":"2006"},{"key":"e_1_2_7_45_2","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/B978-0-443-07293-2.50006-6","volume-title":"Therapeutic Exercise for Lumbopelvic Stabilisation","author":"Hodges P.","year":"2004"},{"key":"e_1_2_7_46_2","doi-asserted-by":"publisher","DOI":"10.3109\/17453678909154177"},{"key":"e_1_2_7_47_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02527839"},{"key":"e_1_2_7_48_2","volume-title":"Der SF\u201036\u2010Fragebogen zum Gesundheitszustand: Handbuch f\u00fcr die deutschsprachige Fragebogenversion","author":"Bullinger K.","year":"1998"},{"key":"e_1_2_7_49_2","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(93)90127-B"},{"key":"e_1_2_7_50_2","doi-asserted-by":"publisher","DOI":"10.1007\/s004820050114"},{"key":"e_1_2_7_51_2","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(83)90125-2"},{"key":"e_1_2_7_52_2","first-page":"175","volume-title":"Psychotherapeutische Medizin bei chronischem Scmerz: Psychologische Verfahren zur Schmerzkontrolle","author":"Luka\u2010Krausgrill U.","year":"1994"},{"key":"e_1_2_7_53_2","doi-asserted-by":"publisher","DOI":"10.1097\/00002508-199706000-00010"},{"key":"e_1_2_7_54_2","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/014662167700100306","article-title":"The CES\u2010D scale: A self report depression scale for research in the general population","volume":"3","author":"Radloff L.S.","year":"1977","journal-title":"Appl Psych Measurement"},{"key":"e_1_2_7_55_2","volume-title":"Allgemeine Depressionsskala","author":"Hautzinger M.","year":"1995"},{"key":"e_1_2_7_56_2","first-page":"149","article-title":"Selbstwirksamkeitserwartung, Entscheidungsbalance und rueckenbewusstes Verhalten zur Praevention von Rueckenschmerz \u2010 eine Studie zum transtheoretischen Modell","volume":"4","author":"Basler H.D.","year":"1998","journal-title":"Z Med Psychol"},{"key":"e_1_2_7_57_2","first-page":"105","article-title":"Optimistische Kompetenzerwartung: Zur Erfassung einer personellen Ressource","volume":"40","author":"Schwarzer R.","year":"1994","journal-title":"Diagnostica"},{"key":"e_1_2_7_58_2","volume-title":"Messung und Analyse von Arbeitszufriedenheit","author":"Neuberger O.","year":"1978"},{"key":"e_1_2_7_59_2","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1037\/0022-006X.61.4.653","article-title":"Comparison of the efficacy of electromyographic biofeedback, cognitive\u2010behavioral therapy, and conservative medical interventions in the treatment of chronic musculoskeletal pain","volume":"61","author":"Flor H.","year":"1993","journal-title":"J Consul Clin Psychol"},{"key":"e_1_2_7_60_2","doi-asserted-by":"publisher","DOI":"10.1007\/s100670050026"},{"key":"e_1_2_7_61_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198403000-00002"},{"key":"e_1_2_7_62_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198809000-00005"},{"key":"e_1_2_7_63_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198809000-00006"},{"key":"e_1_2_7_64_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.10993"},{"key":"e_1_2_7_65_2","doi-asserted-by":"publisher","DOI":"10.1093\/acprof:oso\/9780195152968.001.0001"},{"key":"e_1_2_7_66_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-198903001-00015"},{"key":"e_1_2_7_67_2","first-page":"231","volume-title":"The Handbook of Research Synthesis","author":"Rosenthal R.","year":"1994"},{"key":"e_1_2_7_68_2","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.112.1.155"},{"key":"e_1_2_7_69_2","unstructured":"Cochrane Handbook for Systematic Reviews of Interventions version 4.2.5http:\/\/www.cochrane.orgMay 2005 Accessed August 1 2005"},{"key":"e_1_2_7_70_2","doi-asserted-by":"publisher","DOI":"10.1016\/0738-3991(89)90005-0"},{"key":"e_1_2_7_71_2","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.clinbiomech.2004.12.006","article-title":"Supplementation of general endurance exercise with stabilisation training versus general exercise only: Physiological and functional outcomes of a randomised controlled trial of patients with recurrent low back pain","volume":"20","author":"Koumantakis G.A.","year":"2005","journal-title":"Clin Biomech"},{"key":"e_1_2_7_72_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000232787.71938.5d"},{"key":"e_1_2_7_73_2","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e31812e0060"},{"key":"e_1_2_7_74_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199912010-00004"},{"key":"e_1_2_7_75_2","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(94)00279-N"},{"key":"e_1_2_7_76_2","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1159\/000289131","article-title":"Agoraphobia and panic disorder: 3.5 years after alprazolam and\/or exposure treatment","volume":"66","author":"Kilic C.","year":"1997","journal-title":"Psychother Psychosom"},{"key":"e_1_2_7_77_2","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.68.6.1020"}],"container-title":["PM&amp;R"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1016%2Fj.pmrj.2009.07.006","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1934148209007163?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1934148209007163?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.pmrj.2009.07.006","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T04:36:50Z","timestamp":1694666210000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1016\/j.pmrj.2009.07.006"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,9]]},"references-count":76,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2009,9]]}},"alternative-id":["10.1016\/j.pmrj.2009.07.006"],"URL":"https:\/\/doi.org\/10.1016\/j.pmrj.2009.07.006","archive":["Portico"],"relation":{},"ISSN":["1934-1482","1934-1563"],"issn-type":[{"value":"1934-1482","type":"print"},{"value":"1934-1563","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,9]]},"assertion":[{"value":"2008-08-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2009-07-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2009-09-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}