Effectiveness of an Extension-Oriented Treatment Approach in a Subgroup of Subjects With Low Back Pain: A Randomized Clinical Trial

Browder, David A.; Childs, John D.; Cleland, Joshua A.; Fritz, Julie M.

doi:10.2522/ptj.20060297

Cited by 123 publications

(103 citation statements)

References 38 publications

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“…On accordance with these study results Murtezani et al (2015) reported that McKenzie intervention indicates significant change in spinal movement, functional capacity and pain relief among patients with chronic LBP [31]. Likewise, McKenzie's method was more effective than lumbar strengthening exercises in treating non-specific low back pain patients [32]. The author of this study did not find differences between both programs.…”

Section: Discussionsupporting

confidence: 77%

Stabilization Versus McKenzie Exercises in Patients With Mechanical Neck Dysfunction

Ammar¹

2018

IJPR

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Background: Mechanical neck dysfunction (MND) is a disabling and costly disorder. There are insufficient data available to determine the efficacy of the stabilization and McKenzie exercises on MND.Purpose: The objective of this study was to compare stabilization exercises to McKenzie exercises in patients with MND.Design: Two group pretest-posttest design.Materials and Methods: Twenty-seven participants were randomly allocated to the stabilization group (n=14) and the McKenzie group (n=13). Each group received treatment twice a week over a 6-week period. Outcome included pain intensity measured on a visual analogue scale, disability measured with the neck disability index, pain threshold measured with the pressure algometer and cervical range of motion measured with an electronic goniometer at baseline and after six weeks of treatment.Results: Pain intensity, functional disability, pain threshold and cervical range of motion showed significant differences in all groups after intervention. However, there were no significant differences between groups.Conclusion: Within the limitations of this study, both programs were equally effective in improving pain, disability, and range of motion of patients with MND.

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Section: Discussionsupporting

confidence: 77%

Stabilization Versus McKenzie Exercises in Patients With Mechanical Neck Dysfunction

Ammar¹

2018

IJPR

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“…Data support use of treatment-based classification systems to enhance patient outcomes, 1,2,10,43 but clinical classification data have not been adequately represented in prior risk-adjusted models used to explain FS outcomes. 8,52,54 Data from our research group suggest that the predictive ability of models improves when variables for classifying patients in clinically logical ways are included.…”

Section: Discussionmentioning

confidence: 99%

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

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Functional status (FS) outcomes of patients with lumbar spine dysfunctions managed in outpatient rehabilitation clinics are affected by many variables, including patient demographic variables. 35 Before clinicians can interpret associations between treatments and outcomes in a meaningful way, FS outcomes must be statistically risk-adjusted to control the effect of variables that may or may not be related to clinical care. 8,23,33,35,52 Although statistical risk adjustment models can appear complicated, 53,54 results of these models tend to be clinically logical. For example, it is clinically logical that patients who are older or patients whose symptoms are more chronic should report less FS change compared to patients who are younger or have more acute symptoms, and, indeed, results support this inverse relationship (ie, as patients age, or symptoms become chronic, FS T T STUDY DESIGN: Retrospective analysis of a prospective, longitudinal cohort study of 30 858 patients being treated for a lumbar spine dysfunction in outpatient physical therapy. T T OBJECTIVES:To determine effect of adding a single-item screening variable classifying patients with elevated versus not-elevated scores of fearavoidance beliefs of physical activities at intake, on a model predicting risk-adjusted functional status (FS) outcomes. T T BACKGROUND:Outcomes must be risk-adjusted before making meaningful interpretations. Elevated fear-avoidance beliefs scores have been predictive of poor outcomes. But the importance of elevated fear-avoidance scores in a multivariable model predicting FS outcomes needs further study. T T METHODS:Using retrospective analyses, predictive ability (R 2 ) of multivariable linear regression models of discharge FS with and without classification by elevated versus not-elevated fearavoidance scores were compared, while controlling for intake FS, age, symptom acuity, surgical history, gender, number of comorbidities, and payer. Percent variance controlled and beta coefficients (95% confidence intervals) of each variable in both models were compared. A split-half design was used for model cross-validation. Predictive ratios (predicted FS, divided by actual discharge FS) were assessed. T T RESULTS:Adding fear-avoidance beliefs classification to the discharge FS model improved (P<.001) model predictive ability but only slightly (R 2 without, and with, fear-avoidance classification, 0.2997 and 0.3010, respectively). Variables impacted models similarly (95% confidence intervals not different). Fear-avoidance classification added 0.2% data variance control to the existing model. Cross-validation was supported. Predictive ratios were 1.09 and 1.10, without and with fearavoidance, respectively. T T CONCLUSION:Although screening for elevated fear-avoidance beliefs of physical activities significantly improves the FS outcomes predictive model, the amount of additional meaningful interpretation of FS outcomes was minimal. Exploration of other clinically relevant variables designed to improve outcomes prediction is warranted...

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“…The primary findings of the study suggest that (1) 11 In addition to reliability and validity, the generalizability of a classification system to guide treatment decision making must also be supported. 48 For a classification system to be clinically useful, the system must enhance patient outcomes as well as account for or include a substantial proportion of potential patients referred to rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…5,10 Although the validity for classifying patients into one of the three MDT mechanical subgroups has not been determined, numerous research studies support CEN as an important prognostic factor and classification category for identifying patients who respond favorably from specific CEN-based interventions. [10][11][12][13][14][15][16][17][18][19][20] Classification by patient response criteria including CEN and directional preference for directing treatment have been frequently recommended by clinicians and researchers. 11,[13][14][15][21][22][23][24][25][26][27][28][29] Similar to the three McKenzie syndromes, a substantial proportion of patients (estimates range between 31 and 87%) seen in physical therapy clinics for treatment of low back pain can be classified into a CEN category at intake.…”

Section: Introductionmentioning

confidence: 99%

“…21 Preliminary efficacy evidence exists for both MDT and TBC classification systems 30,38 as well as classifying patients based on CPR and CEN for treating patients with low back pain. 11,16,21,32,35 However, there are no published studies examining outcomes between patients classified according to McKenzie syndromes, PPC, and CPR categories, which may partially explain why there is a lack of agreement between clinicians and researchers on which classification treatment method works best for which patients. Of interest, there are two case studies comparing MDT versus manipulation CPR classification for a patient with low back pain.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of classification methods for patients with lumbar impairments using the McKenzie syndromes, pain pattern, manipulation, and stabilization clinical prediction rules

Werneke

Hart²,

Oliver³

et al. 2010

Journal of Manual & Manipulative Therapy

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Objectives: Aims were (1) to determine the proportion of patients with lumbar impairments who could be classified at intake by McKenzie syndromes (McK) and pain pattern classification (PPCs) using Mechanical Diagnosis and Therapy (MDT) assessment methods, manipulation, and stabilization clinical prediction rules (CPRs) and (2) McK -derangement 67%, dysfunction 5%, posture 0%, other 28%; PPC -CEN 43%, Non CEN 39%, NC 18%; manipulation CPR -positive 13%; Stab CPR -positive 7%. For patients positive for manipulation CPR (n579), prevalence rates for derangement were 89% and CEN 68%. For patients positive for stabilization CPR (n541), prevalence rates for derangement were 83% and CEN 80%. Discussion: The majority of patients classified based on initial clinical presentation by manipulation and stabilization CPRs were also classified as derangements whose symptoms centralized. Manipulation and stabilization CPRs may not represent a mutually exclusive treatment subgroup but may include patients who can be initially treated using a different classification method.

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Effectiveness of an Extension-Oriented Treatment Approach in a Subgroup of Subjects With Low Back Pain: A Randomized Clinical Trial

Abstract: An EOTA was more effective than trunk strengthening exercise in a subgroup of subjects hypothesized to benefit from this treatment approach. Additional research is needed to explore whether an EOTA may benefit other subgroups of patients.

Cited by 123 publications

References 38 publications

Stabilization Versus McKenzie Exercises in Patients With Mechanical Neck Dysfunction

Stabilization Versus McKenzie Exercises in Patients With Mechanical Neck Dysfunction

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Prevalence of classification methods for patients with lumbar impairments using the McKenzie syndromes, pain pattern, manipulation, and stabilization clinical prediction rules

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