Sistema supervisor para la máquina monobloque

opportunity to exercise and be shown how to do the exercise in the ‘correct way’:

they were (not) going to actually…physically going to show you the exercises that you need to do…I think is sort of a real key to you know keeping flexibility right, making sure you are doing the exercise right. Because some people can do an exercise completely wrong and they’re not stretching the muscle they’re supposed to be stretching. [Interviewee 19] It would better that…if the exercises could actually be conducted in the sessions…It’s not that we weren’t allowed to do it, I should say. It’s just that we weren’t given the opportunity to do the exercise. [Interviewee 31]

One interviewee said that the exercises were ineffective for them. This interviewee was unable to attend any of the groups:

…she gave me a set of exercises to do but they didn’t seem to help you know, stretches and exercises but that didn’t seem to help. [Interviewee 33]

One interviewee was already doing a lot of exercise: I’m already exercising more than most people exercise. [Interviewee 23]

Goal setting

Of the 16 interviewees, 13 talked about setting goals collaboratively with the therapist at the initial assessment.

Goal setting was popular with six interviewees: What mine (goal) was, was to walk to the shop and back and I did it within the first couple of weeks because the car was off the road so I had to do it and I was so pleased when I’d done it that I actually made it there and back. [Interviewee 24]

Well I have joined the gym so that was one of my goals to go back and do that, but then I’ve got to work on that. [Interviewee 32]

Goal setting was already being used by a further two interviewees:

Many things I learned on the course I already worked out myself over time…I’ve achieved the

goal that I actually set on the course with the swimming. [Interviewee 23]

Goal setting was not used by three interviewees: I’m not bothered about goal setting. [Interviewee 22]

I felt I wasn’t particularly bad enough to have to set goals, because it isn’t restricting me in the way it was probably affecting other people. [Interviewee 26]

I mean I’d like to go on it every day and do ‘x’ amount of time on it, but at the moment like I say, I actually haven’t but that was one of my goals. [Interviewee 30]

Two interviewees felt that goal setting would be good for others:

For some people I’m sure it’s good, but for me personally…I was happier just doing it my way in the end. [Interviewee 20]

BeST intervention folder

Seven interviewees mentioned the folder.

Five interviewees found the folder good, of whom three specifically mentioned exercises and one used it for reference:

It showed you exercises, it explained back pain, that going round in a circle. It gave me goals, what to deal with um...and once you’d done with one goal…you know, ‘do you want to lead on to another goal?’ With the exercises you started at one level and if you wanted to carry on different levels but each week we were given two pages about what we talked about that day which was very good. [Interviewee 24]

Yes I did actually think it was quite useful but yes it has been quite good and I have referred to it strangely enough. [Interviewee 25] No one used the logbooks.

Relationship with therapist

The relationship with the therapist at the initial assessment was described as positive or helpful by four interviewees:

She was very good, everything was explained. She asked…she waited for us to answer and if we had any questions she’d listen to us and

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she’d…you didn’t feel as though you were being rushed. [Interviewee 24]

I felt quite uplifted when I came out actually, that somebody perhaps wanted to help me. I don’t know. Whether just that feeling of, ‘someone’s listening’. [Interviewee 32] Group sessions

Out of the 16 interviewees who attended for the initial assessment only 12 attended one or more group sessions. Their accounts of the group sessions are presented under the following themes: change in fear avoidance, value of interaction, pacing, pain education, relaxation and reinforcement. The final section reports the negative comments about the group sessions. Change in fear avoidance

The most marked change in attitudes, beliefs and behaviours attributed to the group sessions was a decrease in fear avoidance, described by 10 interviewees:

I always assumed that if I was in pain that I was going to damage it (the back)…I’ll take paracetamol or the Ibuleve gel around the area and since going on the course, try and exercise; try and move it, try and free it up, whereas previously I’d have followed the…you know, lay down, rested it and I sort of picked up on that and it did make a difference the other day for sure. [Interviewee 20]

I would take it easy and I will try and restrict the amount of heavy lifting I done I wouldn’t lift it…I were conscious of not damaging it… because I was frightened to do these because what’s the point of exercising and then doing your back in like? I’m not so worried about it now. [Interviewee 21]

You’re afraid that if you push yourself too far that maybe you’re doing more damage to your back…but as I say, that was good in the fact that what it showed me is that I can push myself that little bit further with the pain, and it’s not actually doing any damage. [Interviewee 31]

The only things that have changed from the trial is that I will attempt more things…even though it hurts. [Interviewee 23]

I’d probably say it’s (back pain) on a similar scale of what it was, but not…it’s not

I’m not sitting there thinking about my back constantly basically, thinking ‘Oh well I can’t do that. Can I lift that?’ I’d just go and lift it and lift it carefully. [Interviewee 26]

One interviewee talked of still being fear avoidant: I like to do it if I can but I’m wary of it that is the main thing. I’m frightened of it…it sounds silly but I’d like to put it in a washing machine, wash it and put it back new which will never happen but yeah I’m frightened to do anything new with it in case it does it, I’ll do it bit by bit…I prefer to do it bit by bit than to see how far I can go…years ago I’d have gone and done a whole lot but now you won’t because you’re frightened of your back. [Interviewee 24] An understanding of cycles of pain and the link with fear avoidance was expressed by five interviewees:

I did tend to protect my back, I did tend to… but obviously if you’re not going to use your back then you’re going to lose your back, you know and you get into the circles and the whole thing made a lot of sense really. [Interviewee 21]

I guess that is a good thing to do, you know, to use the exercises because it is an absolute vicious circle. You don’t exercise because your back hurts which in turn weakens your muscle which in turn makes your back bad and you’re on the treadmill really so it’s difficult. [Interviewee 25]

What I’ve tended to do as a result of the sessions is even though my back is aching I’ve pushed myself and not given in. I’ve gone on and done something and like…you know… I’ve gone down and taken her (niece) to the swimming baths. [Interviewee 31]

Value of interaction in the group sessions

The opportunity to share views and experiences with the group was valued by nine interviewees:

The difficulties they were having were all quite common with the difficulties I was having and from that, I found it quite comforting. [Interviewee 31]

Sometimes you can pick up more from the people because they’ve done things or

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