A Randomized Controlled Trial on the Effectiveness of a Classification-Based System for Subacute and Chronic Low Back Pain

Apeldoorn, Adri T.; Ostelo, Raymond; Helvoirt, Hans van; Fritz, Julie M.; Knol, Dirk L.; Tulder, Maurits W. van; Vet, Henrica C.W. de

doi:10.1097/brs.0b013e31824d9f2b

Cited by 70 publications

(25 citation statements)

References 23 publications

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“…This is in concordance with recent studies that found 26%, 8 34%, 6 and 50% 11 of patients with unclear classifications. Interestingly, we found almost no difference in the inter-rater reliability between patients with a clear classification and an unclear classification.…”

Section: 11supporting

confidence: 82%

“…This designation is consistent with that in the study of Fritz et al 7 Relevant research experience involved the development of a randomized controlled trial 13 to assess the effectiveness of Delitto et al's system. 5 In the conduct of the randomized controlled trial, 8 the first rater (AA) assessed 150 patients according to the system and discussed the outcomes regularly with the second rater (HvH) who had used the system in clinical care for 2 years. The third rater (HM) is a diplomat in MDT with minimal algorithm experience.…”

Section: Methods Ratersmentioning

confidence: 99%

“…3). In a study of Apeldoorn et al, 8 raters were allowed to discuss examination findings. They reported a very good inter-rater reliability (97% agreement, Kappa 0.95).…”

Section: 11mentioning

confidence: 99%

“…It is not surprising that the study by Apeldoorn et al 8 showed almost perfect agreement because raters assessed each patient together and could influence each other's opinion. The two vignette studies found somewhat better agreement scores compared to most of the studies that used repeated assessments.…”

mentioning

confidence: 99%

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Inter-rater reliability of a modified version of Delitto et al.’s classification-based system for low back pain: a pilot study

Apeldoorn

Helvoirt²,

Ostelo

et al. 2016

Journal of Manual & Manipulative Therapy

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Study design: Observational inter-rater reliability study. Objectives: To examine: (1) the inter-rater reliability of a modified version of Delitto et al.'s classificationbased algorithm for patients with low back pain; (2) the influence of different levels of familiarity with the system; and (3) the inter-rater reliability of algorithm decisions in patients who clearly fit into a subgroup (clear classifications) and those who do not (unclear classifications). Methods: Patients were examined twice on the same day by two of three participating physical therapists with different levels of familiarity with the system. Patients were classified into one of four classification groups. Raters were blind to the others' classification decision. In order to quantify the inter-rater reliability, percentages of agreement and Cohen's Kappa were calculated. Results: A total of 36 patients were included (clear classification n523; unclear classification n513). The overall rate of agreement was 53% and the Kappa value was 0.34 [95% confidence interval (CI): 0.11-0.57], which indicated only fair inter-rater reliability. Inter-rater reliability for patients with a clear classification (agreement 52%, Kappa value 0.29) was not higher than for patients with an unclear classification (agreement 54%, Kappa value 0.33). Familiarity with the system (i.e. trained with written instructions and previous research experience with the algorithm) did not improve the inter-rater reliability. Conclusion: Our pilot study challenges the inter-rater reliability of the classification procedure in clinical practice. Therefore, more knowledge is needed about factors that affect the inter-rater reliability, in order to improve the clinical applicability of the classification scheme.

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Section: 11supporting

confidence: 82%

Section: Methods Ratersmentioning

confidence: 99%

“…3). In a study of Apeldoorn et al, 8 raters were allowed to discuss examination findings. They reported a very good inter-rater reliability (97% agreement, Kappa 0.95).…”

Section: 11mentioning

confidence: 99%

mentioning

confidence: 99%

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Inter-rater reliability of a modified version of Delitto et al.’s classification-based system for low back pain: a pilot study

Apeldoorn

Helvoirt²,

Ostelo

et al. 2016

Journal of Manual & Manipulative Therapy

Self Cite

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“…15,43,44 Apeldoorn et al 44 reported a mean baseline score of 6.06 on the NRS, which was lowered to 4.04 following 8 weeks of treatment with Delitto et al's TBC system. Our mean NRS scores were 3.43 at baseline and 0.23 at discharge, and were achieved within 1 month for most patients.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Patient Outcomes Using the MyoKinesthetic System for the Treatment of Low Back Pain: A Case Series

Brody

Nasypany

Baker

et al. 2017

Journal of Chiropractic Medicine

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Objective: The purpose of this case series was to test the feasibility of using the MyoKinesthetic (MYK) System as a treatment-based classification system and intervention for a sample of patients with low back pain. Methods: This within-subject intervention was completed in a university athletic training clinic. Nine participants (mean age: 31 years) with a primary complaint of LBP were evaluated and included. An athletic trainer performed the initial assessment, which contained the following components: patient history, palpation, range of motion testing, lower quarter neurologic screening, MYK System posture screen, orthopedic special tests, and baseline data for pain intensity, disability, and function. All participants were treated with the MYK System. The primary outcomes were pain, disability, function, active range of motion, posture, and global efficacy of treatment. Results: The mean number of MYK treatments administered was 12.11 (SD = 6.25), and the mean number of days until discharge was 28.67 (SD = 9.38). A repeated-measures analysis of variance revealed statistically significant and clinically meaningful improvements in pain, disability, function, and posture from the initial evaluation to discharge and from the initial evaluation to a 1-month follow-up (P b .01). Conclusion: This study determined the feasibility of further evaluation of the MYK System as a treatment-based classification system and intervention for patients with low back pain. (J Chiropr Med 2017;16:111-121)

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The McKenzie method for (sub)acute non-specific low back pain

Almeida

Garcia

Costa

et al. 2023

Cochrane Database of Systematic Reviews

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A Randomized Controlled Trial on the Effectiveness of a Classification-Based System for Subacute and Chronic Low Back Pain

Abstract: The classification-based system used in this study was not effective for improving physical therapy care outcomes in a population of patients with subacute and chronic low back pain.

Cited by 70 publications

References 23 publications

Inter-rater reliability of a modified version of Delitto et al.’s classification-based system for low back pain: a pilot study

Inter-rater reliability of a modified version of Delitto et al.’s classification-based system for low back pain: a pilot study

Analysis of Patient Outcomes Using the MyoKinesthetic System for the Treatment of Low Back Pain: A Case Series

The McKenzie method for (sub)acute non-specific low back pain

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