Efficacy of Flexion and Extension Treatments Incorpoatin Braces for Low-Back Pain Patienst With Rerodiplacement, Spondylolisthesis, or Normal Sagittal Translation

Spratt, Kevin F.; Weinstein, James Neil; Lehmann, Thomas R.; Woody, Joyce; Sayre, Hutha A.

doi:10.1097/00007632-199310000-00020

Cited by 76 publications

(36 citation statements)

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“…For simplicity, each comparison was treated as an individual trial. Trials reported on the following categories of interventions: acupuncture (10 trials) [25,42,73,74,85,95,99,104,106,128], back school (2 trials) [11,28], behavioural (7 trials) [10,21,62,111,130,132,133], electrotherapy (20 trials) [8, 15, 25, 27, 37, 49-51, 54, 57, 63, 69, 76, 77, 89, 94, 107, 122, 137, 143], exercise (10 trials) [29,37,43,48,50,59,67,116,131,136], heatwrap therapy (2 trials) [109,110], insoles (1 trial) [127], magnets (1 trial) [33], massage (1 trial) [116], neuroreflexotherapy (1 trial) [93] [16,117,129]. Trial characteristics are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

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Imperfect placebos are common in low back pain trials: a systematic review of the literature

et al. 2008

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The placebo is an important tool to blind patients to treatment allocation and therefore minimise some sources of bias in clinical trials. However, placebos that are improperly designed or implemented may introduce bias into trials. The purpose of this systematic review was to evaluate the adequacy of placebo interventions used in low back pain trials. Electronic databases were searched systematically for randomised placebo-controlled trials of conservative interventions for low back pain. Trial selection and data extraction were performed by two reviewers independently. A total of 126 trials using over 25 different placebo interventions were included. The strategy most commonly used to enhance blinding was the provision of structurally equivalent placebos. Adequacy of blinding was assessed in only 13% of trials. In 20% of trials the placebo intervention was a potentially genuine treatment. Most trials that assessed patients' expectations showed that the placebo generated lower expectations than the experimental intervention. Taken together, these results demonstrate that imperfect placebos are common in low back pain trials; a result suggesting that many trials provide potentially biased estimates of treatment efficacy. This finding has implications for the interpretation of published trials and the design of future trials. Implementation of strategies to facilitate blinding and balance expectations in randomised groups need a higher priority in low back pain research.

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Section: Resultsmentioning

confidence: 99%

“…Six trials scored 3 points or less on the PEDro scale [48,50,121,131,132,136] and two pharmaceutical trials scored the maximum of 10 points [41,108]. Over 25 different substances or procedures were used as placebo interventions.…”

Section: Resultsmentioning

confidence: 99%

Imperfect placebos are common in low back pain trials: a systematic review of the literature

et al. 2008

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“…Diagnosis of LSI have been developed traditionally from studies that have examined intersegmental linear and angular displacement using lateral flexion-extension radiographs and reported some threshold values [6][7][8][9][10][11][12][13][14][15][16][17][18][19] but unfortunately their usefulness is controversial. The use of these criteria for identifying LSI has proven unsatisfactory because of high false-positive rates [7,12].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the increased recognition of lumbar segmental instability (LSI) as an identifiable subgroup within this population [3][4][5], the identification of reliable and valid clinical diagnostic tools has thus far been elusive [4]. The diagnostic standard for LSI has traditionally centered on identifying excessive translational or rotational movements between lumbar vertebrae by using functional (flexion-extension) radiographs [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. There may be other factors as well, such as neuromuscular control of spinal movement and aberrant or abnormal midrange motion characteristics.…”

Section: Introductionmentioning

confidence: 99%

Kinematic analysis of dynamic lumbar motion in patients with lumbar segmental instability using digital videofluoroscopy

et al. 2009

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The study design is a prospective, case-control. The aim of this study was to develop a reliable measurement technique for the assessment of lumbar spine kinematics using digital video fluoroscopy in a group of patients with low back pain (LBP) and a control group. Lumbar segmental instability (LSI) is one subgroup of nonspecific LBP the diagnosis of which has not been clarified. The diagnosis of LSI has traditionally relied on the use of lateral functional (flexion-extension) radiographs but use of this method has proven unsatisfactory. Fifteen patients with chronic low back pain suspected to have LSI and 15 matched healthy subjects were recruited. Pulsed digital videofluoroscopy was used to investigate kinematics of lumbar motion segments during flexion and extension movements in vivo. Intersegmental linear translation and angular displacement, and pathway of instantaneous center of rotation (PICR) were calculated for each lumbar motion segment. Movement pattern of lumbar spine between two groups and during the full sagittal plane range of motion were analyzed using ANOVA with repeated measures design. Intersegmental linear translation was significantly higher in patients during both flexion and extension movements at L5-S1 segment (p \ 0.05). Arc length of PICR was significantly higher in patients for L1-L2 and L5-S1 motion segments during extension movement (p \ 0.05). This study determined some kinematic differences between two groups during the full range of lumbar spine. Devices, such as digital videofluoroscopy can assist in identifying better criteria for diagnosis of LSI in otherwise nonspecific low back pain patients in hope of providing more specific treatment.

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“…Spratt et al [54] evaluated the influence of combined treatment of bracing, exercises and education controlling either flexion or extension postures on patients with radiographic instability. Fifty-six patients meeting strict study inclusion and radiographic evaluation criteria were assigned to a bracing treatment (flexion, extension, placebo-control) according to a randomization scheme, designed to ensure equal representation of translation categories (retrolisthesis, normal, spondylolisthesis) across treatment groups, and assessed at admission and 1-month follow-up.…”

Section: Bracingmentioning

confidence: 99%

Diagnosis and conservative management of degenerative lumbar spondylolisthesis

2007

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Degenerative spondylolisthesis (DS) is a disorder that causes the slip of one vertebral body over the one below due to degenerative changes in the spine. Lumbar DS is a major cause of spinal canal stenosis and is often related to low back and leg pain. We reviewed the symptoms, prognosis and conservative treatments for symptoms associated with DS. PubMed and MEDLINE databases (1950-2007) were searched for

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Efficacy of Flexion and Extension Treatments Incorpoatin Braces for Low-Back Pain Patienst With Rerodiplacement, Spondylolisthesis, or Normal Sagittal Translation

Cited by 76 publications

References 0 publications

Imperfect placebos are common in low back pain trials: a systematic review of the literature

Imperfect placebos are common in low back pain trials: a systematic review of the literature

Kinematic analysis of dynamic lumbar motion in patients with lumbar segmental instability using digital videofluoroscopy

Diagnosis and conservative management of degenerative lumbar spondylolisthesis

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