Derivation of clinical prediction rules for identifying patients with non-acute low back pain who respond best to a lumbar stabilization exercise program at post-treatment and six-month follow-up

Abstract

Low back pain (LBP) remains one of the most common and incapacitating health conditions worldwide. Clinical guidelines recommend exercise programs after the acute phase, but clinical effects are modest when assessed at a population level. Research needs to determine who is likely to benefit from specific exercise interventions, based on clinical presentation. This study aimed to derive clinical prediction rules (CPRs) for treatment success, using a lumbar stabilization exercise program (LSEP), at the end of treatment and at six-month follow-up. The eight-week LSEP, including clinical sessions and home exercises, was completed by 110 participants with non-acute LBP, with 100 retained at the six-month follow-up. Physical (lumbar segmental instability, motor control impairments, posture and range of motion, trunk muscle endurance and physical performance tests) and psychological (related to fear-avoidance and home-exercise adherence) measures were collected at a baseline clinical exam. Multivariate logistic regression models were used to predict clinical success, as defined by ≥50% decrease in the Oswestry Disability Index. CPRs were derived for success at program completion (T8) and six-month follow-up (T34), negotiating between predictive ability and clinical usability. The chosen CPRs contained four (T8) and three (T34) clinical tests, all theoretically related to spinal instability, making these CPRs specific to the treatment provided (LSEP). The chosen CPRs provided a positive likelihood ratio of 17.9 (T8) and 8.2 (T34), when two or more tests were positive. When applying these CPRs, the probability of treatment success rose from 49% to 96% at T8 and from 53% to 92% at T34. These results support the further development of these CPRs by proceeding to the validation stage.

The relationships between spinal amplitude of movement, pain and disability in low back pain: A systematic review and meta‐analysis

“…Relationships based on cross‐sectional data between spinal amplitude and disability were available for 69 studies and 5899 participants (Adamu et al, 2019; Alschuler et al, 2009; Alves et al, 2020; Ansari et al, 2014; Atya, 2013; Aure & Kvåle, 2022; Bayar et al, 2003; Bazzaz‐Yamchi et al, 2021; Caporaso et al, 2012; Carrasco‐Martínez et al, 2019; Christe et al, 2016; Coyle et al, 2017; de Brito Macedo et al, 2019; Demoulin et al, 2013; Deyo, 1986; Dubois et al, 2016; Duray et al, 2018; Ekedahl et al, 2010; Fehrmann et al, 2017; Felicio et al, 2017; Garcia et al, 2013; Grönblad et al, 1997; Grosdent et al, 2023; Grotle et al, 2004; Hidalgo et al, 2015; Hofste et al, 2021; Hrkać et al, 2022; Hurri et al, 1995; Ibrahim et al, 2019; Jette et al, 2016; Joshi et al, 2021; Kang et al, 1995; Karayannis et al, 2023; Kiran et al, 2017; La Touche et al, 2019; Larivière et al, 2022; Lee et al, 2001; Lenoir dit Caron et al, 2022; Loisel et al, 1998; Louw et al, 2015; Louw, Farrell, et al, 2017; Mannion et al, 2001; Matheve et al, 2019; Melikoglu et al, 2009; Miyachi et al, 2021; Nattrass et al, 1999; Nemcić et al, 2013; Nordstoga et al, 2019; Ostelo et al, 2003; Ozkaraoglu et al, 2020; Parks et al, 2003; Rainville et al, 1994; Sakulsriprasert et al, 2011; Sasani et al, 2008; Satpute et al, 2019; Scharovsky et al,…”

“…For the relationship between change in spinal amplitude and change in disability, based on longitudinal data, 33 studies with 2437 participants were included in the meta‐analysis (Alves et al, 2020; Anderson et al, 2013; Ansari et al, 2014; Bazzaz‐Yamchi et al, 2021; Caporaso et al, 2012; de Brito Macedo et al, 2019; Ekedahl et al, 2012; Garcia et al, 2013; George et al, 2006; Grosdent et al, 2023; Hrkać et al, 2022; Hurri et al, 1995; Joshi et al, 2021; Kiran et al, 2017; Larivière et al, 2022; Lenoir dit Caron et al, 2022; Loisel et al, 1998; Mannion et al, 2012; Martin et al, 1986; Mellin et al, 1989; Mieritz et al, 2014; Nemcić et al, 2013; Nordstoga et al, 2019; Ozkaraoglu et al, 2020; Sakulsriprasert et al, 2011; Satpute et al, 2019; Shahvarpour et al, 2017; Silveira et al, 2021; Steele et al, 2013; Sturion et al, 2020; Sullivan et al, 2000; Takinacı et al, 2019; Taşpınar et al, 2023; Vowles et al, 2007). The pooled coefficient was −0.23 [95%CI −0.31 to −0.15], indicating that an increase in spinal amplitude was associated with a decrease in disability (Figure 3).…”

“…Relationships based on cross‐sectional data between spinal amplitude and pain intensity were available for 74 studies with 5806 participants (Alschuler et al, 2009; Alves et al, 2020; Anderson et al, 2013; Ansari et al, 2014; Aure & Kvåle, 2022; Bazzaz‐Yamchi et al, 2021; Caporaso et al, 2012; Carpino et al, 2020; Carrasco‐Martínez et al, 2019; Christe et al, 2016; Coyle et al, 2017; de Brito Macedo et al, 2019; Demoulin et al, 2013; Du et al, 2017; Dubois et al, 2016; Duray et al, 2018; Fehrmann et al, 2017; Garcia et al, 2013; Geller et al, 2016; Grosdent et al, 2023; Grotle et al, 2004; Hidalgo et al, 2015; Hofste et al, 2021; Hrkać et al, 2022; Ibrahim et al, 2019; Jensen et al, 2010; Jette et al, 2016; Joshi et al, 2021; Kernan & Rainville, 2007; Kienbacher et al, 2017; Kiran et al, 2017; Larivière et al, 2022; Lenoir dit Caron et al, 2022; Louw et al, 2015; Louw, Farrell, et al, 2017; Louw, Zimney, et al, 2017; Mannion et al, 2001; Marich et al, 2017; Matheve et al, 2019; McCracken et al, 2002; Melikoglu et al, 2009; Mieritz et al, 2014; Miyachi et al, 2021; Neblett et al, 2013; Nemcić et al, 2013; Nordstoga et al, 2019; Olaogun et al, 2004; Ostelo et al, 2003; Osumi et al, 2019; Ozkaraoglu et al, 2020; Pagé et al, 2015; Papciak & Feuerstein, 1991; Peng et al, 2016; Preyde, 2000; Sakulsriprasert et al, 2011…”

“…Thirty‐eight studies, totaling 2172 participants, were included in the meta‐analysis about the longitudinal relationship between the change in spinal amplitude and the change in pain intensity (Alves et al, 2020; Anderson et al, 2013; Ansari et al, 2014; Bazzaz‐Yamchi et al, 2021; Beladev & Masharawi, 2011; Boucher et al, 2018; Christe et al, 2022; de Brito Macedo et al, 2019; Elnaggar et al, 1991; Ferguson, 1998; Garcia et al, 2013; George et al, 2006; Grosdent et al, 2023; Hrkać et al, 2022; Joshi et al, 2021; Kim et al, 2015; Kiran et al, 2017; Larivière et al, 2022; Lenoir dit Caron et al, 2022; Louw et al, 2015; Louw, Farrell, et al, 2017; Louw, Zimney, et al, 2017; Martin et al, 1986; Masharawi & Nadaf, 2013; McCracken et al, 2002; Mieritz et al, 2014; Nemcić et al, 2013; Nordstoga et al, 2019; Ozkaraoglu et al, 2020; Sakulsriprasert et al, 2011; Satpute et al, 2019; Shahvarpour et al, 2017; Silveira et al, 2021; Steele et al, 2013; Sturion et al, 2020; Takinacı et al, 2019; Taşpınar et al, 2023). The pooled coefficient was −0.25 [95% CI: −0.33 to −0.17] indicating that an increase in spinal amplitude was associated with a decrease in pain intensity (Figure 5).…”

Disability reduction following a lumbar stabilization exercise program for low back pain: large vs. small improvement subgroup analyses of physical and psychological variables

“…A preliminary clinical prediction rule (CPR), at the derivation stage (n = 54 participants), has been proposed [11], but its formal validation was unsuccessful due to a lack of statistical power [12]. Our group has more recently conducted a cohort (observational) study to derive CPRs of success (or large improvement) at the end of the eight-week treatment (n = 110 participants) and at the six-month follow-up (n = 100 participants), using disability as the main clinical outcome [13]. Several candidate predictors of clinical success were measured at baseline for the CPRs development but were also measured at mid-treatment (psychological variables) as well at the end of treatment (physical and psychological variables) and six-month follow-up (psychological variables).…”