Tailored Motor Skill Training Improves Outcomes in Chronic Low Back Pain

older woman in fitness class
Exercise is recommended for chronic low back pain, but no specific exercise-based treatment has been found to be most effective.

Person-specific motor-skill training leads to greater short- and long-term functional improvements in people with chronic low back pain compared with strength and flexibility exercise, according to study results published in JAMA Neurology.

Researchers conducted a single-blind, randomized clinical trial (ClinicalTrials.gov identifier NCT02027623) of people with chronic nonspecific low back pain between 2013 and 2016. Adults with at least 12 months of pain were randomly assigned to receive either person-specific motor skill training or strength and flexibility exercise.

The primary outcome was Modified Oswestry Disability Questionnaire (MODQ) score, evaluated at baseline, 6 months, and 12 months posttreatment. The cohort included 149 participants (91 female; mean age, 42.5±11.7 years).

During the treatment phase of the study, motor skill training reduced MODQ scores by 7.9 (95% CI, 4.7-11.0; P <.001), a greater reduction than that with strength and flexibility exercises. At 6 and 12 months, the motor skill training group maintained lower MODQ score levels compared with the strength and flexibility exercise group (5.6 at 6 months and 5.7 at 12 months). Booster sessions after 6-month follow-up did not change scores in either treatment modality. The standardized mean difference was large after treatment (0.85; 95% CI, 0.51-1.19) and moderate after 12 months (0.56; 95% CI, 0.22-0.90).

Secondary outcomes — including satisfaction with care, improvement in average and worst lower back pain, and physical function, among others — were statistically significantly higher with motor skill training.

No serious adverse events were reported. Nonserious adverse events included worsening of lower back pain in 62 participants.

Study limitations include a lack of generalizability of the findings to people with anatomically specific low back pain conditions, behavioral or psychological comorbidities, below-knee symptoms, or high levels of pain and functional limitation. Researchers also noted that they cannot account for how patient education or employment level, or therapist training, may affect results.

“Our study provides evidence that person-specific [motor skill training] in [low back pain]-limited functional activities results in greater short-term and long-term improvements in function than traditional strength and flexibility exercise,” the researchers concluded. “Such benefits could be key in a condition typically characterized by a clinical course of recurrent, fluctuating, or persistent functional limitation and pain.”

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


van Dillen LR, Lanier VM, Sterger-May K, et al. Effect of motor skill training in functional activities vs strength and flexibility exercise on function in people with chronic low back pain: a randomized clinical trial. Published online December 28, 2020. JAMA Neurol. doi:10.1001/jamaneurol.2020.4821