Comparison of a Functional Restoration Program With Active Individual Physical Therapy for Patients With Chronic Low Back Pain: A Randomized Controlled Trial

Roché, G; Ponthieux, Anne; Parot-Shinkel, Elsa; Jousset, Nathalie; Bontoux, L.; Dubus, V.; Penneau-Fontbonne, D.; Roquelaure, Yves; Legrand, Érick; Colin, D.; Rodet-Belarbi, Isabelle; Fanello, S.

doi:10.1016/j.apmr.2007.07.014

Cited by 70 publications

(53 citation statements)

References 49 publications

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“…Seven studies [52,54,56,57,[61][62][63] examined the relationship between changes in pain and changes in muscular endurance, but none of them reported any specific correlation coefficients to substantiate their statements that there was no significant correlation between the variables.…”

Section: Correlation Between Changes In Pain With Changes In Flexion mentioning

confidence: 99%

Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review

et al. 2011

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Introduction The effect size for exercise therapy in the treatment of chronic non-specific low back pain (cLBP) is only modest. This review aims to analyse the specificity of the effect by examining the relationship between the changes in clinical outcome (pain, disability) and the changes in the targeted aspects of physical function (muscle strength, mobility, muscular endurance) after exercise therapy. Methods We searched for exercise therapy trials for cLBP published up to 15 April 2010 in Medline, Embase, Cochrane Library, Cinahl, and PEDro. Two independent reviewers selected studies according to the inclusion criteria. Data extraction: one author extracted the data of the articles. Results Data synthesis: 16 studies with a total of 1,476 participants met the inclusion criteria. There was little evidence supporting a relationship between the changes in pain or physical function and the changes in performance for the following measures: mobility (no correlation in 9 studies, weak correlation in 1 study), trunk extension strength (7 and 2, respectively), trunk flexion strength (4 and 1, respectively) and back muscle endurance (7 and 0, respectively). Changes in disability showed no correlation with changes in mobility in three studies and a weak correlation in two; for strength, the numbers were four (no correlation) and two (weak correlation), respectively. ConclusionsThe findings do not support the notion that the treatment effects of exercise therapy in cLBP are directly attributable to changes in the musculoskeletal system. Future research aimed at increasing the effectiveness of exercise therapy in cLBP should explore the coincidental factors influencing symptom improvement.

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Section: Correlation Between Changes In Pain With Changes In Flexion mentioning

confidence: 99%

Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review

et al. 2011

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“… Sometimes it was not clear from methods that subgroups analyses were going to be performed; they were just presented in the results 62,69,74,80  All papers measured subgroups of interest prior to randomisation, with most using adequate measurements  Prior to performing analyses only one paper reported the expected size and direction of the subgroup effect. 58 A further three papers predicted the direction of the subgroup effect  A third (13/39) of the papers provided some justification regarding the choice of subgroups to be analysed.…”

mentioning

confidence: 99%

“… Sometimes it was not clear from methods that subgroups analyses were going to be performed; they were just presented in the results 62,69,74,80  All papers measured subgroups of interest prior to randomisation, with most using adequate measurements 45,48,61, 72,75, 77  Four studies reported only the interaction effect sizes with confidence intervals 46,58,59, 82  Eight studies reported the p-values only 37,50,66,67,69, 83,86,88  Nine papers did not report either the interaction effect sizes or confidence intervals or p-values. 49, 60, 62-65, 68, 70, 71  Four studies reported subgroup analyses within individual subgroups rather than between group interaction.…”

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confidence: 99%

Identifying back pain subgroups: developing and applying approaches using individual patient data collected within clinical trials

Patel

Hee

Mistry

et al. 2016

Programme Grants Appl Res

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Total word count including appendix: 93,499 ii ABSTRACT BackgroundThere is good evidence that therapist delivered interventions have modest beneficial effects for people with low back pain (LBP). Identification of subgroups of people with LBP who may benefit from these different treatment approaches is an important research priority. Aim and objectivesOverall aim was to improve the clinical and cost-effectiveness of LBP treatment by providing patients, their clinical advisors, and health service purchasers with better information about which participants are most likely to benefit from which treatment To achieve these objectives required substantial methodological work including the development and evaluation of some novel statistical approaches. This programme of work was not designed to analyse main effect of interventions and no such interpretations should be made.iii MethodsFirstly, we reviewed the literature on treatment moderators and subgroups. We initially invited investigators of trials of therapist-delivered interventions for LBP with >179 participants to share their data with us; some further smaller trials offered to us were also included. Using these trials we developed a repository of individual participant data of therapist delivered interventions for LBP. Using this dataset we sought to identify which participant characteristics, if any, predict response to different treatments (moderators) for clinical and cost effectiveness outcomes.We did an ANCOVA to identify potential moderators to apply in our main analyses.Subsequently we developed and applied three methods of subgroup identification; recursive partitioning (interaction trees and subgroup identification based on a differential effect search), adaptive risk group refinement, and an individual participant data indirect network meta-analysis to identify sub-groups defined by multiple parameters. ResultsWe included data from 19 randomised controlled trials with 9,328 participants (mean age 49 years, 57% females). Our prespecified analyses using recursive partitioning and adaptive risk group refinement performed well and allowed us to identify some subgroups. The differences in the effect size in the different subgroups were typically small, and unlikely to be clinically meaningful. Increasing baseline severity on the outcome of interest was the strongest driver of sub-group identification that we identified. Additionally we explored the application of Bayesian indirect network metaanalysis. This method produced varying probabilities that a particular treatment choice would be most likely to be effective for a specific patient profile. ConclusionThese data lack clinical or cost-effectiveness justification for the use of baseline characteristics in the development of subgroups for back pain. The methodological developments from this work have the potential to be applied in other clinical areas.iv The pooled repository database will serve as a valuable resource to the LBP research community. FundingFunding from the NIHR Programme Grants for Ap...

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“…The multimodal disability management approach consists of cognitive-behavioral therapy, stress management/biofeedback training, education, and vocational reintegration. 9 The FRP has demonstrated positive outcomes for patients with chronic disabling occupational musculoskeletal disorders (CDOMDs), 10 and also patients in the subcategory of musculoskeletal disorders, such as lumbar, [11][12][13][14][15][16] cervical, 17,18 lower extremity, and upper extremity disorders. 19,20 A great deal of clinical findings assessing the effectiveness of FRPs indicate a high rate of success, as measured by physical and psychosocial improvement, as well as socioeconomic outcome variables, including work return and work retention, indicating that patients are once again becoming productive members of society.…”

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confidence: 99%

Does Classification of Chronic Musculoskeletal Disorder Patients Into Psychosocial Subgroups Predict Differential Treatment Responsiveness and 1-Year Outcomes After a Functional Restoration Program?

Asih

Mayer

Williams

et al. 2015

The Clinical Journal of Pain

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Comparison of a Functional Restoration Program With Active Individual Physical Therapy for Patients With Chronic Low Back Pain: A Randomized Controlled Trial

Cited by 70 publications

References 49 publications

Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review

Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review

Identifying back pain subgroups: developing and applying approaches using individual patient data collected within clinical trials

Does Classification of Chronic Musculoskeletal Disorder Patients Into Psychosocial Subgroups Predict Differential Treatment Responsiveness and 1-Year Outcomes After a Functional Restoration Program?

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