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Harrison JJ, Brismée JM, Sizer PS, Denny BK, Sobczak S. Sustained versus repetitive standing trunk extension results in greater spinal growth and pain improvement in back pain:A randomized clinical trial. J Back Musculoskelet Rehabil 2024; 37:395-405. [PMID: 38108341 DOI: 10.3233/bmr-230118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND McKenzie standing trunk extension exercises have been used for the management of low back pain (LBP). However, no study to date has investigated the effect of standing trunk extension postures on spinal height and clinical outcomes. OBJECTIVE To evaluate in subjects with LBP following a period of trunk loading how spinal height, pain, symptoms' centralization and function outcome measures respond to two standing postures interventions: (1) repetitive trunk extension (RTE) and (2) sustained trunk extension (STE). METHODS A consecutive sample of convenience of people with LBP were recruited to participate in 2-session physical therapy using either RTE or STE in standing. RESULTS Thirty participants (18 women) with a mean age of 53 ± 17.5 years completed the study. The first session resulted in spinal height increase (spinal growth) of 2.07 ± 1.32 mm for the RTE intervention and 4.54 ± 1.61 mm for the STE group (p< 0.001; ES = 1.67), while the second session (2-week following the first session) resulted in spinal growth of 2.39 ± 1.46 mm for the RTE group and 3.91 ± 2.06 mm for the STE group (p= 0.027; ES = 0.85). The STE group presented with the larger reduction in most pain from 6 to 2 as compared to the RTE group from 6 to 4 between Session 1 and Session 2 (p< 0.001). There was no difference between the groups in Modified Oswestry score and symptoms centralization (p= 0.88 and p= 0.77, respectively). CONCLUSION People with LBP experienced greater spine growth and improvements of pain during standing STE as compared to RTE. People with LBP could use such postures and movements to alleviate their LBP and improve spine height while in a weight bearing position.
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Affiliation(s)
- Jeremy J Harrison
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
- Sports Medicine and Physical Therapy, Outpatient Orthopedic Clinic, Fredericksburg, TX, USA
| | - Jean-Michel Brismée
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Phillip S Sizer
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Brent K Denny
- Center for Rehabilitation Research, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Stéphane Sobczak
- Département D'Anatomie, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Unité de Recherche en Anatomie Clinique et Fonctionnelle (URACEF), Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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IJzelenberg W, Oosterhuis T, Hayden JA, Koes BW, van Tulder MW, Rubinstein SM, de Zoete A. Exercise therapy for treatment of acute non-specific low back pain. Cochrane Database Syst Rev 2023; 8:CD009365. [PMID: 37646368 PMCID: PMC10467021 DOI: 10.1002/14651858.cd009365.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Low back pain (LBP) is the leading cause of disability globally. It generates considerable direct costs (healthcare) and indirect costs (lost productivity). The many available treatments for LBP include exercise therapy, which is practised extensively worldwide. OBJECTIVES To evaluate the benefits and harms of exercise therapy for acute non-specific low back pain in adults compared to sham/placebo treatment or no treatment at short-term, intermediate-term, and long-term follow-up. SEARCH METHODS This is an update of a Cochrane Review first published in 2005. We conducted an updated search for randomised controlled trials (RCTs) in CENTRAL, MEDLINE, Embase, four other databases, and two trial registers. We screened the reference lists of all included studies and relevant systematic reviews published since 2004. SELECTION CRITERIA We included RCTs that examined the effects of exercise therapy on non-specific LBP lasting six weeks or less in adults. Major outcomes for this review were pain, functional status, and perceived recovery. Minor outcomes were return to work, health-related quality of life, and adverse events. Our main comparisons were exercise therapy versus sham/placebo treatment and exercise therapy versus no treatment. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. We evaluated outcomes at short-term follow-up (time point within three months and closest to six weeks after randomisation; main follow-up), intermediate-term follow-up (between nine months and closest to six months), and long-term follow-up (after nine months and closest to 12 months); and we used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 23 studies (13 from the previous review, 10 new studies) that involved 2674 participants and provided data for 2637 participants. Three small studies are awaiting classification, and four eligible studies are ongoing. Included studies were conducted in Europe (N = 9), the Asia-Pacific region (N = 9), and North America (N = 5); and most took place in a primary care setting (N = 12), secondary care setting (N = 6), or both (N = 1). In most studies, the population was middle-aged and included men and women. We judged 10 studies (43%) at low risk of bias with regard to sequence generation and allocation concealment. Blinding is not feasible in exercise therapy, introducing performance and detection bias. There is very low-certainty evidence that exercise therapy compared with sham/placebo treatment has no clinically relevant effect on pain scores in the short term (mean difference (MD) -0.80, 95% confidence interval (CI) -5.79 to 4.19; 1 study, 299 participants). The absolute difference was 1% less pain (95% CI 4% more to 6% less), and the relative difference was 4% less pain (95% CI 20% more to 28% less). The mean pain score was 20.1 (standard deviation (SD) 21) for the intervention group and 20.9 (SD 23) for the control group. There is very low-certainty evidence that exercise therapy compared with sham/placebo treatment has no clinically relevant effect on functional status scores in the short term (MD 2.00, 95% CI -2.20 to 6.20; 1 study, 299 participants). The absolute difference was 2% worse functional status (95% CI 2% better to 6% worse), and the relative difference was 15% worse (95% CI 17% better to 47% worse). The mean functional status score was 15.3 (SD 19) for the intervention group and 13.3 (SD 18) for the control group. We downgraded the certainty of the evidence for pain and functional status by one level for risk of bias and by two levels for imprecision (only one study with fewer than 400 participants). There is very low-certainty evidence that exercise therapy compared with no treatment has no clinically relevant effect on pain or functional status in the short term (2 studies, 157 participants). We downgraded the certainty of the evidence by two levels for imprecision and by one level for inconsistency. One study associated exercise with small benefits and the other found no differences. The first study was conducted in an occupational healthcare centre, where participants received one exercise therapy session. The other study was conducted in secondary and tertiary care settings, where participants received treatment three times per week for six weeks. We did not pool data from these studies owing to considerable clinical heterogeneity. In two studies, there were no reported adverse events. One study reported adverse events unrelated to exercise therapy. The remaining studies did not report whether any adverse events had occurred. Owing to insufficient reporting of adverse events, we were unable to reach any conclusions on the safety or harms related to exercise therapy. AUTHORS' CONCLUSIONS Exercise therapy compared to sham/placebo treatment may have no clinically relevant effect on pain or functional status in the short term in people with acute non-specific LBP, but the evidence is very uncertain. Exercise therapy compared to no treatment may have no clinically relevant effect on pain or functional status in the short term in people with acute non-specific LBP, but the evidence is very uncertain. We downgraded the certainty of the evidence to very low for inconsistency, risk of bias concerns, and imprecision (few participants).
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Affiliation(s)
- Wilhelmina IJzelenberg
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Teddy Oosterhuis
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Bart W Koes
- Department of General Practice, Erasmus Medical Center, Rotterdam, Netherlands
- Center for Muscle and Health, University of Southern Denmark, Odense, Denmark
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department Physiotherapy & Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Sidney M Rubinstein
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annemarie de Zoete
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Louw A, Farrell K, Nielsen A, O’Malley M, Cox T, Puentedura EJ. Virtual McKenzie extension exercises for low back and leg pain: a prospective pilot exploratory case series. J Man Manip Ther 2023; 31:46-52. [PMID: 35739614 PMCID: PMC9848382 DOI: 10.1080/10669817.2022.2092822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Current evidence supports the inclusion of directional preference exercises for a subgroup of patients with low back (LBP) and leg pain. Recent pain neuroscience strategies have suggested that cortical restructuring associated with movement activating the body map representation in the brain might account for the observed improvement with the directional preference approach. OBJECTIVES To explore whether or not a motor imagery directional preference approach would result in any changes in patients with LBP and leg pain. METHODS A consecutive convenience sample of patients with LBP and leg pain were recruited at two outpatient physical therapy clinics. Measurements of LBP, leg pain, fear-avoidance beliefs (FABQ), pain catastrophizing (PCS), active lumbar flexion, and straight leg raise (SLR) were compared before and immediately after a virtual (motor imagery) directional preference exercise. RESULTS Statistically significant differences for LBP, FABQ, PCS, active lumbar flexion, and SLR were observed, but only SLR changes met or exceeded the minimally clinically important difference (MCID). CONCLUSIONS A brief virtual motor imagery extension treatment yielded some immediate positive shifts in patients presenting to physical therapy with LBP and leg pain. Our results indicate that randomized comparison trials are needed to determine the effect of this intervention on the short- and longer-term outcomes in patients with LBP and leg pain.
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Affiliation(s)
- Adriaan Louw
- Department of Physical Therapy, Evidence in Motion, Story City, IA, USA
| | - Kevin Farrell
- Department of Physical Therapy Education, Residency Program, St. Ambrose University, Health Sciences Center, Davenport, IA, USA
| | - Anthony Nielsen
- Department of Physical Therapy, Rock Valley Physical Therapy, Bettendorf, IA, USA
| | - Max O’Malley
- Department of Physical Therapy, AMN Healthcare, Lincolnwood, IL, USA
| | - Terry Cox
- Department of Physical Therapy, Southwest Baptist University, Bolivar, MO, USA
| | - Emilio J. Puentedura
- Doctor of Physical Therapy Program, Baylor University, Robbins College of Health and Human Sciences, Waco, TX, USA,CONTACT Emilio J. Puentedura Doctor of Physical Therapy Program, Baylor University, Robbins College of Health and Human Sciences, One Bear Place, Waco, TX97303, USA
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Park SC, Kang MS, Yang JH, Kim TH. Assessment and nonsurgical management of low back pain: a narrative review. Korean J Intern Med 2023; 38:16-26. [PMID: 36420562 PMCID: PMC9816685 DOI: 10.3904/kjim.2022.250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/26/2022] [Indexed: 11/25/2022] Open
Abstract
Low back pain (LBP) is a common condition that affects people of all ages and income levels worldwide. The etiology of LBP may be mechanical, neuropathic, systemic, referred visceral, or secondary to other causes. Despite numerous studies, the diagnosis and management of LBP remain challenging due to the complex biomechanics of the spine and confounding factors, such as trivial degenerative imaging findings irrelevant to symptoms and psychological and emotional factors. However, it is imperative to identify the crucial signs ("red flags") indicating a serious underlying condition. While many recent guidelines emphasize non-pharmacologic management approaches, such as education, reassurance, and physical and psychological care, as the first option, LBP patients in many countries, including South Korea, are prescribed medications. Multidisciplinary rehabilitation combined with prudent use of medications is required in patients unresponsive to first-line therapy. The development of practical guidelines apposite for South Korea is needed with multidisciplinary discussion.
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Affiliation(s)
- Sung Cheol Park
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Min-Seok Kang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Jae Hyuk Yang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul,
Korea
| | - Tae-Hoon Kim
- Department of Orthopedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul,
Korea
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Sousa Filho LF, Barbosa Santos MM, Matos Vasconcelos DB, Soares EA, dos Santos GHF, da Silva Júnior WM. Neurodynamic exercises provide no additional benefit to extension-oriented exercises in people with chronic low back-related leg pain and a directional preference: A randomized clinical trial. J Bodyw Mov Ther 2022; 30:140-147. [DOI: 10.1016/j.jbmt.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
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Classification Approaches for Treating Low Back Pain Have Small Effects That Are Not Clinically Meaningful: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2022; 52:67-84. [PMID: 34775831 DOI: 10.2519/jospt.2022.10761] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether classification systems improve patient-reported outcomes for people with low back pain (LBP). DESIGN Systematic review with meta-analysis. LITERATURE SEARCH The MEDLINE, Embase, CINAHL, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials databases were searched from inception to June 21, 2021. Reference lists of prior systematic reviews and included trials were screened. STUDY SELECTION CRITERIA We included randomized trials comparing a classification system (eg, the McKenzie method or the STarT Back Tool) to any comparator. Studies evaluating participants with specific spinal conditions (eg, fractures or tumors) were excluded. DATA SYNTHESIS Outcomes were patient-reported LBP intensity, leg pain intensity, and disability. We used the revised Cochrane Collaboration Risk of Bias Tool to assess risk of bias, and the Grading of Recommendations Assessment, Development and Evaluation approach to judge the certainty of evidence. We used random-effects meta-analysis, with the Hartung-Knapp-Sidik- Jonkman adjustment, to estimate the standardized mean difference (SMD; Hedges' g) and 95% confidence interval (CI). Subgroup analyses explored classification system, comparator type, pain type, and pain duration. RESULTS Twenty-four trials assessing classification systems and 34 assessing subclasses were included. There was low certainty of a small effect at the end of intervention for LBP intensity (SMD, -0.31; 95% CI: -0.54, -0.07; P = .014, n = 4416, n = 21 trials) and disability (SMD, -0.27; 95% CI: -0.46, -0.07; P = .011, n = 4809, n = 24 trials), favoring classified treatments compared to generalized interventions, but not for leg pain intensity. At the end of intervention, no specific type of classification system was superior to generalized interventions for improving pain intensity and disability. None of the estimates exceeded the effect size that one would consider clinically meaningful. CONCLUSION For patient-reported pain intensity and disability, there is insufficient evidence supporting the use of classification systems over generalized interventions when managing LBP. J Orthop Sports Phys Ther 2022;52(2):67-84. Epub 15 Nov 2021. doi:10.2519/jospt.2022.10761.
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Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting technique is associated with LBP. PLoS One 2021; 16:e0254241. [PMID: 34288926 PMCID: PMC8294511 DOI: 10.1371/journal.pone.0254241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/22/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose To investigate if lumbar and lower limb kinematics or kinetics are different between groups with and without a history of LBP during lifting. Secondly, to investigate relationships between biomechanical variables and pain ramp during repeated lifting. Methods 21 LBP and 20 noLBP participants completed a 100-lift task, where lumbar and lower limb kinematics and kinetics were measured during lifting, with a simultaneous report of LBP intensity every 10 lifts. Lifts were performed in a laboratory setting, limiting ecological validity. Results The LBP group used a different lifting technique to the noLBP group at the beginning of the task (slower and more squat-like). Kinetic differences at the beginning included less peak lumbar external anterior shear force and greater peak knee power demonstrated by the LBP group. However, at the end of the task, both groups lifted with a much more similar technique that could be classified as more stoop-like and faster. Peak knee power remained greater in the LBP group throughout and was the only kinetic difference between groups at the end of the lifting task. While both groups lifted using a more comparable technique at the end, the LBP group still demonstrated a tendency to perform a slower and more squat-like lift throughout the task. Only one of 21 variables (pelvic tilt at box lift-off), was associated with pain ramp in the LBP group. Conclusions: Workers with a history of LBP, lift with a style that is slower and more squat-like than workers without any history of LBP. Common assumptions that LBP is associated with lumbar kinematics or kinetics such as greater lumbar flexion or greater forces were not observed in this study, raising questions about the current paradigm around ‘safe lifting’.
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Longtin C, Décary S, Cook CE, Tousignant-Laflamme Y. What does it take to facilitate the integration of clinical practice guidelines for the management of low back pain into practice? Part 2: A strategic plan to activate dissemination. Pain Pract 2021; 22:107-112. [PMID: 33998767 DOI: 10.1111/papr.13032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023]
Abstract
Low back pain (LBP) is the leading cause of disability worldwide among all musculoskeletal disorders despite an intense focus in research efforts. Researchers and decision makers have produced multiple clinical practice guidelines for the rehabilitation of LBP, which contain specific recommendations for clinicians. Adherence to these recommendations may have several benefits, such as improving the quality of care for patients living with LBP, by ensuring that the best evidence-based care is being delivered. However, clinicians' adherence to recommendations from these guidelines is low and numerous implementation barriers and challenges, such as complexity of information and sheer volume of guidelines have been documented. In a previous paper, we performed a systematic review of the literature to identify high-quality clinical practice guidelines on the management of LBP, and developed a concise yet comprehensive infographic that summarizes the recommendations from these guidelines. Considering the wealth of scientific evidence, passive dissemination alone of this research knowledge is likely to have limitations to help clinicians implement these recommendations into routine practice. Thus, an active and engaging dissemination strategy, aimed at improving the implementation and integration of specific recommendations into practice is warranted. In this paper, we argue that a conceptual framework, such as the theoretical domains framework, could facilitate the implementation of these recommendations into clinical practice. Specifically, we present a systematic approach that could serve to guide the development of a theory-informed knowledge translation intervention as a means to overcome implementation challenges in rehabilitation of LBP.
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Affiliation(s)
- Christian Longtin
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada
| | - Simon Décary
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada.,Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada
| | - Chad E Cook
- Department of Orthopedics, Duke University, Durham, North Carolina, USA
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada.,Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada
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Longtin C, Décary S, Cook CE, Tousignant-Laflamme Y. What does it take to facilitate the integration of clinical practice guidelines for the management of low back pain into practice? Part 1: A synthesis of recommendation. Pain Pract 2021; 21:943-954. [PMID: 33998769 DOI: 10.1111/papr.13033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/18/2021] [Accepted: 03/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Despite the emergence of multiple clinical practice guidelines (CPGs) for the rehabilitation of low back pain (LBP) over the last decade, self-reported levels of disability in this population have not improved. This may be explained by the numerous implementation barriers, such as the complexity of information and sheer volumes of CPGs. OBJECTIVES The purpose of this study was to summarize the evidence and recommendations from the most recent and high-quality CPGs on the rehabilitation management of LBP by developing an infographic summarizing the recommendations to facilitate dissemination into clinical practice. METHODS We performed a systematic review of high-quality CPGs with an emphasis on rehabilitation approaches. We searched major health-related research databases (e.g., PubMed, CINAHL, and PEDro). We performed quality assessment via the AGREE-II instrument. Contents of the CPGs were synthesized by extracting recommendations, which were then compared to one another to identify consistencies based on an iterative evaluation process. RESULTS We identified and assessed 5 recent high-quality CPGs. We synthesized 13 recommendations on the rehabilitation management of LBP (2 for screening procedures, 3 for assessment procedures, and 8 involving treatment approaches) and 2 underlying principles were highlighted. These results were then synthetized and illustrated in a concise infographic that serves as a conceptual roadmap that identifies the specific behavior changes (i.e., adoption of CPGs' recommendations) rehabilitation professionals should adopt in order to integrate an evidenced-based approach for the management of LBP. CONCLUSIONS We systematically reviewed the literature for CPGs' recommendations for the physical rehabilitation management of LBP and synthesized the information through an infographic.
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Affiliation(s)
- Christian Longtin
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada
| | - Simon Décary
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada.,Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada
| | - Chad E Cook
- Department of Orthopaedics, Duke University, Durham, North Carolina, USA
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada.,Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada
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10
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Karlsson M, Bergenheim A, Larsson MEH, Nordeman L, van Tulder M, Bernhardsson S. Effects of exercise therapy in patients with acute low back pain: a systematic review of systematic reviews. Syst Rev 2020; 9:182. [PMID: 32795336 PMCID: PMC7427286 DOI: 10.1186/s13643-020-01412-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 06/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute low back pain is associated with pain and disability, but symptoms are often self-healing. The effectiveness of exercise therapy for acute low back pain remains uncertain with conflicting evidence from systematic reviews. The aim of this systematic review of systematic reviews was to assess the overall certainty of evidence for the effects of exercise therapy, compared with other interventions, on pain, disability, recurrence, and adverse effects in adult patients with acute low back pain. METHODS PubMed, the Cochrane library, CINAHL, PEDro, Open Grey, Web of Science, and PROSPERO were searched for systematic reviews of randomized controlled trials. Methodological quality was assessed independently by two authors using AMSTAR. Meta-analyses were performed if possible, using data from the original studies. Data for pain, disability, recurrence, and adverse effects were analyzed. Certainty of evidence was assessed using GRADE. RESULTS The searches retrieved 2602 records, of which 134 publications were selected for full-text screening. Twenty-four reviews were included, in which 21 randomized controlled trials (n = 2685) presented data for an acute population, related to 69 comparisons. Overlap was high, 76%, with a corrected covered area of 0.14. Methodological quality varied from low to high. Exercise therapy was categorized into general exercise therapy, stabilization exercise, and McKenzie therapy. No important difference in pain or disability was evident when exercise therapy was compared with sham ultrasound, nor for the comparators usual care, spinal manipulative therapy, advice to stay active, and educational booklet. Neither McKenzie therapy nor stabilization exercise yielded any important difference in effects compared with other types of exercise therapy. Certainty of evidence varied from very low to moderate. CONCLUSIONS The findings suggest very low to moderate certainty of evidence that exercise therapy may result in little or no important difference in pain or disability, compared with other interventions, in adult patients with acute low back pain. A limitation of this systematic review is that some included reviews were of low quality. When implementing findings of this systematic review in clinical practice, patients' preferences and the clinician's expertise also should be considered, to determine if and when exercise therapy should be the intervention of choice. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD46146, available at: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=46146 .
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Affiliation(s)
- Marc Karlsson
- Region Skåne, Healthcare Centre Oxie, Malmö, Sweden.,Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Anna Bergenheim
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Uddevalla Rehabilitation, Uddevalla, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, 6th floor, SE-412 19, Gothenburg, Sweden
| | - Maria E H Larsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, 6th floor, SE-412 19, Gothenburg, Sweden
| | - Lena Nordeman
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, 6th floor, SE-412 19, Gothenburg, Sweden
| | - Maurits van Tulder
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department Physiotherapy & Occupational Therapy, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Susanne Bernhardsson
- Department of Health and Rehabilitation, Unit of Physiotherapy, The Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden. .,Region Västra Götaland, Research and Development Primary Health Care, Kungsgatan 12, 6th floor, SE-412 19, Gothenburg, Sweden.
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Abstract
Low back pain is the leading cause of incapacitation and medical rehabilitation. The purpose of this German National Health Care Guideline "Nonspecific low back pain" is to optimize the care of patients with low back pain. This guideline was drawn up by 29 professional societies and organizations. In the case of nonspecific low back pain, a detailed medical history and physical examination should be carried out first, but no further diagnostics unless there are indications of the so-called "red flags". For symptomatic treatment, medicine should be given in low doses, and physical activity should be in the foreground. A physician should act as a point of contact throughout the course of the disease, and the patient must be continuously educated and motivated to have a healthy lifestyle, including regular physical activity.
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Affiliation(s)
- Wolfgang Reith
- Klinik für Diagnostische, und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg-Saar, Deutschland.
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Tousignant-Laflamme Y, Cook CE, Mathieu A, Naye F, Wellens F, Wideman T, Martel MO, Lam OTT. Operationalization of the new Pain and Disability Drivers Management model: A modified Delphi survey of multidisciplinary pain management experts. J Eval Clin Pract 2020; 26:316-325. [PMID: 31270904 DOI: 10.1111/jep.13190] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND We recently proposed the Pain and Disability Drivers Management (PDDM) model, which was designed to outline comprehensive factors driving pain and disability in low back pain (LBP). Although we have hypothesized and proposed 41 elements, which make up the model's five domains, we have yet to assess the external validity of the PDDM's elements by expert consensus. RESEARCH OBJECTIVES This study aimed to reach consensus among experts regarding the different elements that should be included in each domain of the PDDM model. RELEVANCE The PDDM may assist clinicians and researchers in the delivery of targeted care and ultimately enhance treatment outcomes in LBP. METHODS Using a modified Delphi survey, a two-round online questionnaire was administered to a group of experts in musculoskeletal pain management. Participants were asked to rate the relevance of each element proposed within the model. Participants were also invited to add and rate new elements. Consensus was defined by a greater than or equal to 75% level of agreement. RESULTS A total of 47 (round 1) and 33 (round 2) participants completed the survey. Following the first round, 38 of 41 of the former model elements reached consensus, and 10 new elements were proposed and later rated in the second round. Following this second round, consensus was reached for all elements (10 new + 3 from first round), generating a final model composed of 51 elements. CONCLUSION This expert consensus-derived list of clinical elements related to the management of LBP represents a first step in the validation of the PDDM model.
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Affiliation(s)
- Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Chad E Cook
- Physical Therapy Division, Duke University, Durham, North Carolina
| | - Annie Mathieu
- Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST), Montreal, Quebec, Canada
| | - Florian Naye
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Frédéric Wellens
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Timothy Wideman
- Physio Axis, Prévost, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Marc-Olivier Martel
- Faculties of Dentistry & Medicine, McGill University, Montreal, Quebec, Canada
| | - Olivier Tri-Trinh Lam
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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13
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The Evolving Case Supporting Individualised Physiotherapy for Low Back Pain. J Clin Med 2019; 8:jcm8091334. [PMID: 31466408 PMCID: PMC6780711 DOI: 10.3390/jcm8091334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 02/06/2023] Open
Abstract
Low-back pain (LBP) is one of the most burdensome health problems in the world. Guidelines recommend simple treatments such as advice that may result in suboptimal outcomes, particularly when applied to people with complex biopsychosocial barriers to recovery. Individualised physiotherapy has the potential of being more effective for people with LBP; however, there is limited evidence supporting this approach. A series of studies supporting the mechanisms underpinning and effectiveness of the Specific Treatment of Problems of the Spine (STOPS) approach to individualised physiotherapy have been published. The clinical and research implications of these findings are presented and discussed. Treatment based on the STOPS approach should also be considered as an approach to individualised physiotherapy in people with LBP.
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14
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Takasaki H, May S. Are improvements in symptoms associated with changes in lumbopelvic posture in patients with posterior derangement using Mechanical Diagnosis and Therapy? J Back Musculoskelet Rehabil 2019; 32:389-398. [PMID: 30475750 DOI: 10.3233/bmr-181263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mechanical Diagnosis and Therapy (MDT) manages low back pain (LBP) with subgroup classifications. For a subgroup of the posterior derangement syndrome, postural education limiting lumbar flexion is included. However, it is not known if habitual posture in this subgroup actually changes through MDT management because of technical difficulties in monitoring habitual lumbopelvic posture. However, a wearable device, "LUMOback", which can evaluate the proportion of time with a neutral lumbopelvic posture (posture score), has now become available. OBJECTIVE To preliminarily investigate whether the posture score changes through the course of MDT management. METHODS Primary inclusion criterion was LBP with the posterior derangement syndrome. Primary outcome measure was the posture score during one week. The posture score was assessed one week before and six weeks after the initial MDT management, which included extension exercises and postural education. RESULTS All participants (n= 8) reported a successful treatment effect after the 6-week MDT intervention; however, there was no specific trend in the posture score (Friedman test: p= 0.277). CONCLUSIONS This study found evidence that the proportion of time with a neutral lumbopelvic posture during daily living, the posture score, which was measured with the LUMOback, did not systematically change with MDT management.
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Affiliation(s)
- Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Saitama, Japan.,Department of Rehabilitation, Aoki Cho Clinic, Kawaguchi, Saitama, Japan
| | - Stephen May
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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15
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Sousa Filho LF, Barbosa Santos MM, de Farias Neto JP, da Silva Junior WM. The addition of neurodynamic exercises to extension-oriented exercises among patients with chronic back-related leg pain: A study protocol. J Bodyw Mov Ther 2019; 23:473-478. [PMID: 31563358 DOI: 10.1016/j.jbmt.2018.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 06/25/2018] [Accepted: 08/25/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with back-related leg pain exhibit nociceptive and neuropathic characteristics. Few studies have investigated the combination of interventions considering these characteristics. OBJECTIVES To investigate if the addition of neurodynamic exercises (EEN) to extension-oriented exercises (EE) promotes additional benefits in individuals with back-related leg pain and a directional preference. METHODS Patients will be randomized to either EE or EEN. Patients from both groups will receive 7 sessions over 3 weeks. Low back and leg pain, function, quality of life, disability, and global perceived effect will be evaluated at baseline, 3 weeks after randomization and 1-month follow-up. A linear mixed model will be used for outcomes analysis.
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Affiliation(s)
- Luis F Sousa Filho
- Master's Program in Physical Education, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
| | - Marta M Barbosa Santos
- Department of Physiotherapy, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
| | - Jader P de Farias Neto
- Department of Physiotherapy, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
| | - Walderi M da Silva Junior
- Master's Program in Physical Education, Universidade Federal de Sergipe, São Cristovão, Sergipe, Brazil.
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16
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Abstract
Various approaches have been used to guide the treatment of low back pain. These approaches have been considered in isolation and often tested against each other. An alternative view is that a model of care that involves a hybrid approach may benefit patients with low back pain. This commentary considers the potential benefits of a sequentially applied hybrid approach for treatment tailoring to optimize resource allocation to those most likely to require comprehensive care, and then decision making toward treatment paths with the greatest potential for success. In a first step, a prognosis-based approach, such as the Subgroups for Targeted Treatment Back Screening Tool (STarT Back), identifies individuals likely to require greater resource allocation. Although a clear path is indicated toward simple and psychologically informed care for the low- and high-risk groups, respectively, there is limited guidance for the large medium-risk group. For that group, the hybrid model provides a stepwise path of additional methods to guide treatment selection. This includes subgrouping based on pain mechanism to guide priority domains for the next phase, which includes tailoring of psychological and movement-based approaches. Motor control approaches to exercise would be indicated for individuals with medium risk and a nociceptive pain mechanism, with treatment guided by detailed assessment via one of several paradigms. Psychologically informed treatments are tailored to those with medium risk and a predominantly central pain mechanism, guided by detailed assessment of psychosocial features. A hybrid approach to a model of care could simplify treatment selection and take advantage of the benefits of each method in a time- and cost-efficient manner. J Orthop Sports Phys Ther 2019;49(6):453-463. Epub 13 Feb 2019. doi:10.2519/jospt.2019.8774.
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Convergence and Divergence of Exercise-Based Approaches That Incorporate Motor Control for the Management of Low Back Pain. J Orthop Sports Phys Ther 2019; 49:437-452. [PMID: 31092126 DOI: 10.2519/jospt.2019.8451] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many approaches for low back pain (LBP) management focus on modifying motor control, which refers to motor, sensory, and central processes for control of posture and movement. A common assumption across approaches is that the way an individual loads the spine by typical postures, movements, and muscle activation strategies contributes to LBP symptom onset, persistence, and recovery. However, there are also divergent features from one approach to another. This commentary presents key principles of 4 clinical physical therapy approaches, including how each incorporates motor control in LBP management, the convergence and divergence of these approaches, and how they interface with medical LBP management. The approaches considered are movement system impairment syndromes of the lumbar spine, Mechanical Diagnosis and Therapy, motor control training, and the integrated systems model. These were selected to represent the diversity of applications, including approaches using motor control as a central or an adjunct feature, and approaches that are evidence based or evidence informed. This identification of areas of convergence and divergence of approaches is designed to clarify the key aspects of each approach and thereby serve as a guide for the clinician and to provide a platform for considering a hybrid approach tailored to the individual patient. J Orthop Sports Phys Ther 2019;49(6):437-452. Epub 15 May 2019. doi:10.2519/jospt.2019.8451.
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18
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Overall confidence in the results of systematic reviews on exercise therapy for chronic low back pain: a cross-sectional analysis using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) 2 tool. Braz J Phys Ther 2019; 24:103-117. [PMID: 31113734 DOI: 10.1016/j.bjpt.2019.04.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 04/12/2019] [Accepted: 04/17/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the overall confidence in the results of systematic reviews of exercise therapy for chronic non-specific low back pain using the AMSTAR 2 tool. METHODS PubMed, Embase, Cochrane Database of Systematic Reviews, PEDro and CINAHL was searched up to February 2017. Two independent reviewers selected systematic reviews of randomized controlled trials that investigated exercise therapy in patients with low back pain. AMSTAR 2 assessment was performed by pairs of reviewers, and the overall confidence in the results of the systematic reviews were rated as 'High', 'Moderate', 'Low' and 'Critically low'. Descriptive analysis was used to summarize the characteristics of included systematic reviews. The percentage of systematic reviews achieving each item from the AMSTAR 2 and the overall confidence in the results were tabulated. RESULTS The search identified 38 systematic reviews. Most of the reviews included a median of 10 clinical trials and total sample size of 813 participants per review. Five of 38 (13%) reviews were Cochrane reviews, and 8 (21%) systematic reviews had a protocol published or registered prospectively. The overall confidence in the results of 28 reviews (74%) was rated as 'Critically low', 6 (16%) as 'Low', 1 (2%) as Moderate, while 3 of 38 reviews (8%) were rated as 'High'. CONCLUSION The results demonstrate very low confidence in the results of most systematic reviews of exercise in chronic non-specific low back pain. Clinicians are more likely to deliver the most efficacious interventions to patients by critically appraising systematic reviews using AMSTAR 2 before making their decisions.
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19
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An international survey of the comprehensiveness of the McKenzie classification system and the proportions of classifications and directional preferences in patients with spinal pain. Musculoskelet Sci Pract 2019; 39:10-15. [PMID: 30447492 DOI: 10.1016/j.msksp.2018.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/27/2018] [Accepted: 06/16/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Classification of spinal pain has been a key goal identified in the research. However it is not clear if existing classification systems are comprehensive. OBJECTIVE To examine the comprehensiveness and distribution of classifications within the McKenzie classification system (MDT), and the directional preference in consecutive patients with spine pain. STUDY DESIGN Prospective, observational study. METHODS Clinicians with a Diploma in MDT provided data on patients that they had assessed, classified, managed, and then confirmed their classification at discharge. They provided data on the spinal area, the MDT classification, and the loading strategy used in management. RESULTS Fifty-four clinicians from at least 15 different countries provided data on 750 patients: lumbar 64.8%, cervical 29.6%, thoracic 5.6%. The distribution of classifications was as follows: Derangement 75.4%, OTHER 22.8%, Dysfunction 1.7%, Postural syndrome 0.1%. In Derangements 82.5% had a directional preference for extension, 12.9% for lateral forces, and 4.6% for flexion. Those patients classified as one of the OTHER subgroups were given specific classifications. CONCLUSION Derangement was the most common classification and extension was by far the most common directional preference. A substantial proportion were classified as OTHER subgroups, for whom management is less straightforward.
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20
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Ganesh GS, Sahu PK, Das SP, Mishra C, Dhiman S. A subgroup analysis to compare patients with acute low back pain classified as per treatment-based classification. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 24:e1747. [PMID: 30226651 DOI: 10.1002/pri.1747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/17/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The evidence for the effectiveness of interventions targeting acute low back pain (LBP) is suboptimal. It is difficult to identify those patients who are more likely to develop chronic pain and disability after an acute episode of LBP. These shortcomings may be attributed to considering LBP as one homogenous condition. METHODS In this quasi-experimental study, we examined and analysed a prospective cohort of 267 patients with first-onset LBP and classified them into one of the groups based on treatment-based classification: direction-specified exercises (Group 2), manipulation (Group 3), stabilization exercises (Group 4), traction (Group 5), and a physician care group (Group 1). Disability and pain were assessed at baseline, after treatment, and at 6 months using the Oswestry Disability Index and the Numerical Rating Scale, respectively. Comparisons were made between the groups, and we predicted measures of disability and pain intensity at 6 months with age, gender, fear avoidance behaviour, centralization phenomenon (CP), expectations about recovery, CP, group classification, baseline pain, and disability. RESULTS Analysis showed that all the heterogeneous groups of LBP improved their outcomes with the respective treatment provided. However, when the entire sample was considered as one homogenous group of LBP, the results showed improvement with time (p < 0.05) only and no difference was found between groups (p > 0.05). None of the studied factors, except baseline pain (R = 0.227, R2 = 0.051, p < 0.05), were able to accurately predict the development of chronic pain in our study sample. CONCLUSION Though our results showed no differences between the subgroups in the reduction of pain and disability, we conclude that classifying and treating patients with LBP into subgroups based on signs and symptoms produce better outcomes. Baseline pain alone may predict a small percentage of people who may develop chronic pain.
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Affiliation(s)
- G Shankar Ganesh
- Department of Physiotherapy, Composite Regional Centre for Persons with Disabilities, Lucknow, India
| | - Pradeep Kumar Sahu
- Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sakti Prasad Das
- Department of Physical Medicine and Rehabilitation, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, India
| | - Chittaranjan Mishra
- Department of Physiotherapy, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, India
| | - Sapna Dhiman
- Department of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
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21
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Yarznbowicz R, Tao M. Directional preference constructs for patients' low back pain in the absence of centralization. J Man Manip Ther 2018; 26:281-291. [PMID: 30455555 DOI: 10.1080/10669817.2018.1505329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: A detailed description of how Directional Preference (DP) constructs are measured could accelerate research to practice translation and improve research findings for Mechanical Diagnosis and Therapy (MDT) stakeholders. A secondary analysis of a prospective, observational cohort study was conducted to understand (1) the type and prevalence of DP constructs at first examination and (2) the relationships between DP constructs and clinical outcomes at follow-up. Methods: Data were collected and analyzed from 1485 consecutive patients who presented to outpatient, private practice clinics with primary complaints of non-specific low back pain (LBP); 400 patients met the inclusion criteria and completed first examination and follow-up data. Statistical analysis determined prevalence and the relationships between DP constructs at first examination and clinical outcomes at follow-up. Results: The primary findings in this investigation were that (1) the most prevalent DP constructs at first examination were related to range of motion (ROM) and pain intensity (Patient Reported Improvement in ROM (74.8%), Increase in Spine ROM (29.5%), and Pain Intensity Change (17.3%)), (2) all groups improved and made clinically meaningful improvements in disability and pain intensity at follow-up, (3) no clinically significant differences in disability or pain intensity were found between the groups at follow-up, and (4) 26.5% and 6.5% of patients exhibited a relative increase in lumbar spine extension and flexion ROM, respectively, post repeated movement testing on the first examination. Discussion: The findings in this study assist providers in making assessment and treatment decisions with their patients by offering insight regarding the most prevalent DP constructs typically found at the first examination and their subsequent association with outcome when Centralization (CEN) does not occur. Recommendations for researchers have been made to further explore the DP framework used in this study.
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Affiliation(s)
| | - Minjing Tao
- Department of Statistics, Florida State University, Tallahassee, FL, USA
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22
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Takasaki H, May S. Concerns related to the accurate identification of anterior derangement syndrome in mechanical diagnosis and therapy for low back pain: A case report. Physiother Theory Pract 2018; 36:533-541. [DOI: 10.1080/09593985.2018.1488906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Japan
- Department of Rehabilitation, Aoki Chuo Clinic, Kawaguchi, Japan
| | - Stephen May
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
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Yarznbowicz R, Tao M, Owens A, Wlodarski M, Dolutan J. Pain pattern classification and directional preference are associated with clinical outcomes for patients with low back pain. J Man Manip Ther 2018; 26:18-24. [PMID: 29456444 PMCID: PMC5810767 DOI: 10.1080/10669817.2017.1343538] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pain Pattern Classification (PPC) and Directional Preference (DP) have shown merit as reliable and predictable clinical solutions to help reduce the burden posed by low back pain (LBP). We conducted a prospective, observational cohort study to verify the association between PPC, DP, and clinical outcomes. We hypothesized that (1) patients who demonstrated DP Centralization (CEN) would have lower pain intensity and disability at follow-up than patients who demonstrated Non-DP Non-CEN, and (2) the prevalence of DP at first examination would be lowest for patients with chronic LBP and are greater than 65 years old. First examination and follow-up data were completed by 639 patients. Clinical outcome measures, including pain intensity and disability, were collected at first examination and follow-up. Baseline comparisons were made between groups with first examination data only and groups with first examination data and follow-up data. A Pearson's chi-squared test was used to determine differences in prevalence rates for the categorical variables, and two-sample t-tests were used for the continuous variables. A Turkey's range test was used to determine differences in follow-up pain intensity and disability for LBP dual-classifications. Multiple regression was used to investigate DP prevalence considering risk adjusted factors. Overall prevalence of DP was 84.5% and prevalence was lowest for patients with sub-acute symptoms. No significant difference existed for the prevalence of DP for patients based on age. Patients classified as DP CEN had, on average, 1.99 pain intensity units less than patients classified as Non-DP Non-CEN at follow-up. Patients classified as DP CEN had, on average, 3.43 RMDQ units less than patients classified as Non-DP Non-CEN at follow-up.These findings support previous reports, verifying the association between LBP dual-classification schemes and clinical outcomes.
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Affiliation(s)
| | - Minjing Tao
- Department of Statistics, Florida State University, Tallahassee, FL, USA
| | - Alexa Owens
- Department of Statistics, Florida State University, Tallahassee, FL, USA
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Chenot JF, Greitemann B, Kladny B, Petzke F, Pfingsten M, Gabriele Schorr S. Non-Specific Low Back Pain. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:883-890. [PMID: 29321099 PMCID: PMC5769319 DOI: 10.3238/arztebl.2017.0883] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 07/28/2017] [Accepted: 10/26/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND For many years, low back pain has been both the leading cause of days lost from work and the leading indication for medical rehabilitation. The goal of the German Disease Management Guideline (NDMG) on nonspecific low back pain is to improve the treatment of patients with this condition. METHODS The current update of the NDMG on non-specific low back pain is based on articles retrieved by a systematic search of the literature for systematic reviews. Its recommendations for diagnosis and treatment were developed by a collaborative effort of 29 scientific medical societies and organizations and approved in a formal consensus process. RESULTS If the history and physical examination do not arouse any suspicion of a dangerous underlying cause, no further diagnostic evaluation is indicated for the time being. Passive, reactive measures should be taken only in combination with activating measures, or not at all. When drugs are used for symptomatic treatment, patients should be treated with the most suitable drug in the lowest possible dose and for as short a time as possible. CONCLUSION A physician should be in charge of the overall care process. The patient should be kept well informed over the entire course of his or her illness and should be encouraged to adopt a healthful lifestyle, including regular physical exercise.
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Affiliation(s)
- Jean-François Chenot
- Section Family Medicine, Institute for Community Medicine, University Hospital of Greifswald
| | | | - Bernd Kladny
- Department of Orthopedics, Fachklinik Herzogenaurach
| | - Frank Petzke
- ain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen
| | - Michael Pfingsten
- ain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen
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Longtin C, Busseau Y, Jetté M, Cabana-Boucher G, Ouellet C, Lam OTT, Allard P, Tousignant-Laflamme Y. Systematic flexion-based approach for patients with radiological signs of lumbar spinal stenosis: Myth or reality? A retrospective study. Ann Phys Rehabil Med 2017; 61:270-272. [PMID: 28713037 DOI: 10.1016/j.rehab.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/07/2017] [Accepted: 03/17/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Christian Longtin
- School of rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Yannick Busseau
- School of rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Mathieu Jetté
- School of rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Gabriel Cabana-Boucher
- School of rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Christopher Ouellet
- School of rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Olivier Tri-Thinh Lam
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada.
| | - Pierre Allard
- Jewish General Hospital, McGill University, Montreal, Quebec, H3T 1E5, Canada.
| | - Yannick Tousignant-Laflamme
- School of rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, J1H 5N4, Canada; Research Center of the Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada.
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Tousignant-Laflamme Y, Longtin C, Brismée JM. How radiological findings can help or hinder patients' recovery in the rehabilitation management of patients with low back pain: what can clinicians do? J Man Manip Ther 2017; 25:63-65. [PMID: 28559664 DOI: 10.1080/10669817.2017.1309345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Yannick Tousignant-Laflamme
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada.,Research Center of the Centre hospitalier universitaire de Sherbrooke (CRCHUS), Sherbrooke, Canada
| | - Christian Longtin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Jean-Michel Brismée
- Doctor of Science Program in Physical Therapy, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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The Effectiveness of Classification-Specific Physical Therapy for People with Low Back pain Within Dominant Movement-Based Schemes: A Systematic Review. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016. [DOI: 10.5812/ircmj.41959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Surkitt LD, Ford JJ, Chan AYP, Richards MC, Slater SL, Pizzari T, Hahne AJ. Effects of individualised directional preference management versus advice for reducible discogenic pain: A pre-planned secondary analysis of a randomised controlled trial. ACTA ACUST UNITED AC 2016; 25:69-80. [PMID: 27422600 DOI: 10.1016/j.math.2016.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Low back disorders are prevalent and directional preference management is a common treatment with mixed evidence for effectiveness. OBJECTIVES To determine the effectiveness of individualised directional preference management plus guideline-based advice versus advice alone in participants with reducible discogenic pain of 6-week to 6-month duration. DESIGN Pre-planned secondary analysis of a multicentre, parallel group randomised controlled trial. METHODS Participants were randomly allocated to receive a 10-week physiotherapy program of 10-sessions of individualised directional preference management plus guideline-based advice (n = 40) or 2-sessions of advice alone (n = 38). Primary outcomes were back pain, leg pain and activity limitation. Outcomes were taken at baseline and 5, 10, 26, and 52-weeks. RESULTS Between-group differences significantly favoured directional preference management compared with advice for back pain at 5-weeks (1.28; 95% CI 0.34-2.23) and 10-weeks (1.45; 95% CI 0.51-2.40), and leg pain at 10-weeks (1.21; 95% CI 0.04-2.39). These short-term differences were not maintained. There were no significant differences between-groups for activity limitation. Secondary outcomes and responder analyses favoured directional preference management suggesting between-group differences were clinically important. CONCLUSIONS In people with reducible discogenic pain, individualised directional preference management plus guideline-based advice resulted in significant and rapid improvement in short-term back and leg pain compared with advice alone. These effects were not maintained at long-term and there were no differences in activity limitation. Individualised directional preference management could be considered for patients with reducible discogenic pain seeking rapid pain relief however further research is indicated.
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Affiliation(s)
- Luke D Surkitt
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
| | - Jon J Ford
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
| | - Alexander Y P Chan
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
| | - Matthew C Richards
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
| | - Sarah L Slater
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
| | - Tania Pizzari
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
| | - Andrew J Hahne
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
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Widerström B, Olofsson N, Boström C, Rasmussen-Barr E. Feasibility of the subgroup criteria included in the treatment-strategy-based (TREST) classification system (CS) for patients with non-specific low back pain (NSLBP). ACTA ACUST UNITED AC 2016; 23:90-7. [DOI: 10.1016/j.math.2016.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/14/2015] [Accepted: 01/03/2016] [Indexed: 02/06/2023]
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Jacobs JV, Lomond KV, Hitt JR, DeSarno MJ, Bunn JY, Henry SM. Effects of low back pain and of stabilization or movement-system-impairment treatments on induced postural responses: A planned secondary analysis of a randomised controlled trial. MANUAL THERAPY 2016; 21:210-9. [PMID: 26324322 PMCID: PMC4713345 DOI: 10.1016/j.math.2015.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/23/2015] [Accepted: 08/13/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Motor retraining for non-specific chronic low back pain (LBP) often focuses on voluntary postural tasks. This training, however, may not transfer to other known postural impairments, such as automatic postural responses to external perturbations. OBJECTIVES To evaluate the extent current treatments of motor retraining ameliorate impaired postural coordination when responding to a perturbation of standing balance. DESIGN Planned secondary analysis of a prospectively registered (NCT01362049), randomized controlled trial with a blinded assessor. METHOD Sixty-eight subjects with chronic, recurrent, non-specific LBP were allocated to perform a postural response task as a secondary assessment one week before and one week after receiving either stabilization or Movement System Impairment (MSI)-directed treatment over 6 weekly 1-h sessions plus home exercises. For assessment, subjects completed the Oswestry disability and numeric pain rating questionnaires and then performed a postural response task of maintaining standing balance in response to 3 trials in each of 4 randomly presented directions of linear surface translations of the platform under the subjects' feet. Integrated amplitudes of surface electromyography (EMG) were recorded bilaterally from the rectus abdominis (RA), internal oblique (IO), and external oblique (EO) muscles during the postural response task. RESULTS No significant effects of treatment on EMG responses were evident. Oswestry and numeric pain ratings decreased similarly following both treatments. CONCLUSIONS Stabilization and MSI-directed treatments do not affect trunk EMG responses to perturbations of standing balance in people with LBP, suggesting current methods of motor retraining do not sufficiently transfer to tasks of reactive postural control.
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Affiliation(s)
- Jesse V Jacobs
- Department of Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building, 106 Carrigan Drive, Burlington, VT 05405, USA.
| | - Karen V Lomond
- School of Health Sciences, Central Michigan University, 1179 Health Professions Building, Mount Pleasant, MI 48859, USA.
| | - Juvena R Hitt
- Department of Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building, 106 Carrigan Drive, Burlington, VT 05405, USA.
| | - Michael J DeSarno
- Department of Medical Biostatistics, Hills 23C/25H, 105 Carrigan Drive, University of Vermont, Burlington, VT 05405, USA.
| | - Janice Y Bunn
- Department of Medical Biostatistics, Hills 23C/25H, 105 Carrigan Drive, University of Vermont, Burlington, VT 05405, USA.
| | - Sharon M Henry
- Department of Rehabilitation and Movement Science, University of Vermont, 305 Rowell Building, 106 Carrigan Drive, Burlington, VT 05405, USA.
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Demoulin C, Bruyère O, Somville PR, Vanderthommen M. Low back pain-related meta-analysis: Caution is needed when interpreting published research results. World J Meta-Anal 2015; 3:93-96. [DOI: 10.13105/wjma.v3.i2.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 02/21/2015] [Accepted: 04/07/2015] [Indexed: 02/05/2023] Open
Abstract
The systematic reviews (SRs) including a meta-analysis are considered as the top level of evidence. Although the existence of more than a hundred of low back pain (LBP)-related SRs seems very appealing and might therefore suggest significant evidence on the topic, a deep analysis indicates that several of these SRs included only very few studies. Other SRs raise concerns because they included some randomized controlled trials which had a low methodological quality, or some studies which differed significantly regarding the studied populations and/or the experimental procedure. The sometimes controversial results of different SRs conducted on the same topic also highlight the significant influence of the inclusion/exclusion criteria used in the SRs to select the articles. To conclude, although meta-analysis is at the top of the evidence pyramid and have several strengths, the conclusions drawn from SRs should always be interpreted with caution because they can also have weaknesses. This is true, whether it be for LBP-related SRs including a meta-analysis, or any other. Therefore a critical analysis of any SR is always needed before integrating the results of the SR in its own clinical practice. Furthermore, clinical reasoning remains crucial, especially to consider the potential differences between one’s patient and the patients included in the meta-analysis.
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Effect of taping on spinal pain and disability: systematic review and meta-analysis of randomized trials. Phys Ther 2015; 95:493-506. [PMID: 25413622 DOI: 10.2522/ptj.20130619] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 11/13/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Taping is a widely used therapeutic tool for the treatment of musculoskeletal disorders, nevertheless its effectiveness is still uncertain. PURPOSE The purpose of this study was to conduct a current review of randomized controlled trials (RCTs) concerning the effects of elastic and nonelastic taping on spinal pain and disability. DATA SOURCES MEDLINE, CINAHL, EMBASE, PEDro, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, ISI Web of Knowledge, and SPORTDiscus databases were searched. STUDY SELECTION All published RCTs on symptomatic adults with a diagnosis of specific or nonspecific spinal pain, myofascial pain syndrome, or whiplash-associated disorders (WAD) were considered. DATA EXTRACTION Two reviewers independently selected the studies and extracted the results. The quality of individual studies was assessed using the PEDro scale, and the evidence was assessed using GRADE criteria. DATA SYNTHESIS Eight RCTs were included. Meta-analysis of 4 RCTs on low back pain demonstrated that elastic taping does not significantly reduce pain or disability immediately posttreatment, with a standardized mean difference of -0.31 (95% confidence interval=-0.64, 0.02) and -0.23 (95% confidence interval=-0.49, 0.03), respectively. Results from single trials indicated that both elastic and nonelastic taping are not better than placebo or no treatment on spinal disability. Positive results were found only for elastic taping and only for short-term pain reduction in WAD or specific neck pain. Generally, the effect sizes were very small or not clinically relevant, and all results were supported by low-quality evidence. LIMITATIONS The paucity of studies does not permit us to draw any final conclusions. CONCLUSION Although different types of taping were investigated, the results of this systematic review did not show any firm support for their effectiveness.
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Bertozzi L, Valdes K, Vanti C, Negrini S, Pillastrini P, Villafañe JH. Investigation of the effect of conservative interventions in thumb carpometacarpal osteoarthritis: systematic review and meta-analysis. Disabil Rehabil 2015; 37:2025-43. [DOI: 10.3109/09638288.2014.996299] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Tousignant-Laflamme Y, Bourgault P, Houle S, Lafaille J, Roy J, Roy L. Brief education on chronic low back pain: Brief group education for patients with chronic low back pain – a descriptive study. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/1753615413y.0000000019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Chan AYP, Ford JJ, McMeeken JM, Wilde VE. Preliminary evidence for the features of non-reducible discogenic low back pain: survey of an international physiotherapy expert panel with the Delphi technique. Physiotherapy 2013; 99:212-20. [PMID: 23517665 DOI: 10.1016/j.physio.2012.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 09/17/2012] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The lumbar intervertebral disc is a known source of low back pain (LBP). Various clinical features of discogenic pain have been proposed, but none have been validated. Several subgroups of discogenic pain have been hypothesised, with non-reducible discogenic pain (NRDP) proposed as a relevant clinical subgroup. The objectives of this study were to obtain consensus from an expert panel on the features of discogenic low back pain, the existence of subgroups of discogenic LBP, particularly NRDP, and the associated features of NRDP. DESIGN Three-round Delphi survey. PARTICIPANTS Twenty-one international physiotherapists with expertise in LBP. METHODS Panellists listed and ranked features that they believed to be indicative of discogenic pain and NRDP. On completion of Round 3, features with ≥50% agreement between panellists were deemed to have reached consensus. RESULTS After three rounds, 10 features of discogenic LBP were identified. Nineteen of the panellists believed that NRDP was a subgroup of discogenic LBP, and nine features of NRDP were identified. CONCLUSION This study provides preliminary validation for the features associated with discogenic LBP. It also provides evidence supporting the existence and features of NRDP as a separate clinical subgroup of discogenic LBP.
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Affiliation(s)
- A Y P Chan
- School of Physiotherapy, Faculty of Health Sciences, La Trobe University, Bundoora, Australia.
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Ford JJ, Hahne AJ. Complexity in the physiotherapy management of low back disorders: clinical and research implications. ACTA ACUST UNITED AC 2013; 18:438-42. [PMID: 23465961 DOI: 10.1016/j.math.2013.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/17/2013] [Accepted: 01/18/2013] [Indexed: 02/06/2023]
Abstract
Over the past decade a wide variety of approaches for the management of low back disorders (LBD) have been developed and evaluated in clinical trials. As a consequence physiotherapists and researchers interested in LBD are faced with a range of issues to do with complexity. These issues will be explored and suggestions made to improve the delivery of high quality research evidence and better patient outcomes.
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Affiliation(s)
- Jon Joseph Ford
- Low Back Research Team, Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria 3085, Australia.
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Richards MC, Ford JJ, Slater SL, Hahne AJ, Surkitt LD, Davidson M, McMeeken JM. The effectiveness of physiotherapy functional restoration for post-acute low back pain: a systematic review. ACTA ACUST UNITED AC 2012; 18:4-25. [PMID: 22796390 DOI: 10.1016/j.math.2012.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 06/06/2012] [Accepted: 06/11/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND The effectiveness of multidisciplinary treatment for post-acute (>6 weeks) low back pain (LBP) has been established. Physiotherapists have sufficient training to conduct less intensive functional restoration. The effectiveness of physiotherapy functional restoration (PFR) has not been evaluated using current systematic review methodology. OBJECTIVES To determine the effects of PFR for post-acute LBP. DATA SOURCES Electronic databases searched include: MEDLINE, EMBASE, CINAHL, PsycINFO, PEDro and Cochrane CENTRAL. TRIAL ELIGIBILITY CRITERIA: Randomised controlled trials of physiotherapy treatment for post-acute LBP combining exercise and cognitive-behavioural intervention compared with other intervention, no intervention or placebo. TRIAL APPRAISAL AND SYNTHESIS METHODS: Two authors independently extracted data. Risk of bias was assessed using the PEDro scale and overall quality of the body of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Treatment effect sizes and 95% confidence intervals were calculated for pain, function and sick leave. RESULTS Sixteen trials were included. Heterogeneity prevented meta-analysis for most comparisons. Meta-analyses showed moderate to high quality evidence of significant but small effects favouring PFR compared with advice for intermediate term function and intermediate and long term pain. There was however low to moderate quality evidence that PFR was no more effective than a range of other treatment types. Heterogeneous trials frequently contributed to very low quality evidence. CONCLUSIONS Moderate to high quality evidence was found of small effects favouring PFR compared with advice. Preliminary evidence suggested PFR is not different to other treatment types. Further high quality research is required replicating existing trial protocols.
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Affiliation(s)
- Matthew C Richards
- Low Back Research Team, Musculoskeletal Research Centre, Department of Physiotherapy, School of Allied Health, Faculty of Health Sciences, La Trobe University, 3086, Australia.
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