• María José Díaz-Arribas, Francisco M Kovacs, Ana Royuela, Mónica Fernández-Serrano, Lorena Gutiérrez-Fernández, Oscar San Martín-Pariente, Víctor Abraira, Mabel Ramos-Sánchez, Rosa Llorca-Palomera, Pedro Pardo-Hervás, Mario Gestoso, Gracia Camacho Sánchez-Gil, María Ángeles Elena-Lucas, Raquel Paniagua-de-la-Calle, Isabel Castellanos-López, María Ángeles García-Heredia, Ana Miriam Cerón-Sanz, Basilio Victoria-González, Carmen Monsalve-Martín, José María Duque-Heras, Manuel J Juanes-Hernández, Jana Saura-Contí, Juan Luis Soto-Sáez, Carlos Román-Moraleda, César Ruiz-Arias, Beatriz Martín-Mora, Rubén Escolano-García, José Sebastian Cantero-Bengoechea, Elena García-López, Alicia López-Pelegrín, Elena Padilla-Martin, María Martínez-Rodríguez, Joaquín Casillas-Martín, Javier Jerez-Vázquez, Lucía Barrientos-Gómez, and Spanish Back Pain Research Network.
• M.J. Díaz-Arribas, MPT, PhD, Physical Medicine and Rehabilitation Department, Faculty of Medicine, Complutense University, Madrid, Spain; and the Spanish Back Pain Research Network.
• Phys Ther. 2015 Mar 1;95(3):319-36.

BackgroundThe Godelieve Denys-Struyf method (GDS) is a motor learning intervention that may be applied in group or individualized sessions.ObjectiveThe study objective was to compare the effectiveness of routine physical therapy, group GDS (GDS-G) sessions, and group and individualized GDS (GDS-I) sessions.DesignThis was a cluster randomized controlled trial.SettingThe study took place in 21 primary care physical therapy units ("clusters") of the Spanish National Health Service (SNHS).ParticipantsThe participants were 461 people with subacute and chronic low back pain (LBP).InterventionClusters were randomized into 3 groups. All participants received medical treatment and a 15-minute group education session on active management. Additional interventions were as follows: control (fifteen 40-minute sessions of transcutaneous electrical nerve stimulation, microwave treatment, and standardized exercises), GDS-G (eleven 50-minute group GDS sessions), and GDS-I (the same 11 sessions plus four 50-minute individualized GDS sessions).MeasurementsPrimary outcomes at baseline and 2, 6, and 12 months later were LBP and pain referred down the leg (separate pain intensity numeric rating scales) and disability (Roland-Morris Questionnaire [RMQ]). Secondary outcomes were use of medication and self-reported health (mental and physical component summaries of the 12-Item Short-Form Health Survey [SF-12]). Separate linear mixed models for LBP, pain referred down the leg, and disability were developed to adjust for potential confounders. Randomization, outcome assessment, and data analyses were masked.ResultsAt 12 months, disability improved 0.7 (95% confidence interval [CI]=-0.4, 1.8) RMQ point in the control group, 1.5 (95% CI=0.4, 2.7) RMQ points in the GDS-I group, and 2.2 (95% CI=1.2, 3.2) RMQ points in the GDS-G group. There were no differences in pain.LimitationsThe amount of exercise was smaller in the control group, and GDS-I sessions were provided by junior physical therapists.ConclusionsThe improvement in disability was slightly higher with group GDS sessions than with the program routinely used in clusters within the SNHS. Adding individualized GDS sessions eliminated this advantage. Further studies should compare the GDS with other types of exercise.© 2015 American Physical Therapy Association.

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