Outcomes are not different for patient-matched versus nonmatched treatment in subjects with chronic recurrent low back pain: a randomized clinical trial

Abstract

Background Classification schemas for low back pain (LBP), such as the Treatment Based Classification and the Movement System Impairment schemas, use common clinical features to subgroup patients with LBP and are purported to improve treatment outcomes. Purpose To assess if providing matched treatments based on patient specific clinical features led to superior treatment outcomes compared to an unmatched treatment for subjects with chronic, recurrent LBP. Study Design A randomized controlled trial. Patient Sample Subjects (n=124) with LBP (≥ 12 months) with or without recurrences underwent a standardized clinical exam to group them into one of 2 strata: (1) ineligible or (2) eligible for stabilization exercises based on the Treatment Based Classification schema. Subjects underwent additional clinical tests to assign them to one of the 5 possible Movement System Impairment categories. Outcome Measures Questionnaires were collected electronically at: Week 0, prior to treatment; Week 7 (following the 6 weekly, one hour treatment sessions); and 12 months. Using the Oswestry Disability Index (0-100) and the Numeric Pain Rating Scale (0-10), the primary analysis was performed using the intention-to-treat principle. Secondary outcomes included fear-avoidance beliefs as well as psychosocial, work related and general health status. Methods After subjects were categorized based on their particular clinical features using both the Treatment Based Classification and Movement System Impairment schemas, they were randomized into one of two treatments using a 3:1 ratio for matched or unmatched treatments. The treatments were (1) trunk stabilization exercise, or (2) Movement System Impairment-directed exercises. The study was funded by National Institutes of Health (NCMRR/R01HD040909; $1,485,000). There are no study specific conflicts of interest to report. Results Of the patients allocated to treatment for this study, 76 received a matched treatment and 25 received an unmatched treatment. Following treatment, both groups showed a statistically significant improvement in the primary outcome measures and almost all of the secondary measures; however, the matched treatment group did not demonstrate superior outcomes at Week 7 or 12 months, except on one of the secondary measures (Graded Chronic Pain Scale – Disability Scale) (P=0.01). Conclusion Providing a matched treatment based on either the Treatment Based Classification or the Movement System Impairment classification schemas did not improve treatment outcomes compared to an unmatched treatment for patients with chronic LBP, except on one secondary disability measure.

Do measures of surgical effectiveness at 1 year after lumbar spine surgery accurately predict 2-year outcomes?

“…All questionnaires were self-administered and were identical at baseline and 1-, and 2-year follow-ups. Patient-reported outcomes instruments included the ODI low-back disability questionnaire, 4,7,15 SF-36, 21 and numeric rating scales for back and leg pain. 3,5,17 The ODI is a self-administered questionnaire that assesses back-specific function and contains 10 questions with 6 response categories.…”

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

“…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.…”

“…11 Because patient outcomes have improved when patients are provided a subgroup-matched treatment, 1,12-14 research on TBC systems for LBP has become a priority. 11,15 One TBC system, which has not been included in the 4 primary LBP classification systems, 11 is the MyoKinesthetic (MYK) System. The MYK System is used for a variety of musculoskeletal conditions, including LBP.…”

Better targeting care for individuals with low back pain: opportunities and obstacles

“…Stratified care , where patients are classified based on certain characteristics and then matched to appropriate treatment pathways, is one relatively simple and efficient method of targeting care 2 . Subgrouping approaches based on identifying common clinical features, usually within a single dimension (ie, pain characteristics, movement patterns, psychological profiles), have also been proposed as a way to target care 5 . Individualised care goes one step further with each person, as opposed to groups of people, receiving personally tailored care 1 3 4.…”

“…Understandably, many clinicians are happier to focus within their own professional ‘comfort zone’, without exploring other domains. Consequently, most attempts at targeting care have adopted a relatively unidimensional subgrouping approach targeting only one or two domains (eg, physical factors or cognitive) 1 5. It could be argued that this may be adequate, as when one or two important aspects improve (eg, physical activity levels, and/or pain beliefs), the whole clinical picture (across multiple domains) may also improve.…”