Professional Kinesiology Practice for Chronic Low Back Pain: Single-Blind, Randomised Controlled Pilot Study

Abstract

Background: Chronic low back pain is a highly prevalent condition with no definitive treatment. Professional Kinesiology Practice (PKP) is a little known complementary medicine technique using non-standard muscle testing; no previous effectiveness studies have been performed. Methods: This is an exploratory, pragmatic single-blind, 3-arm randomised sham-controlled pilot study with waiting list control (WLC) in private practice UK (2007-2009). 70 participants scoring ≥4 on the Roland and Morris Disability Questionnaire (RMDQ) were randomised to real or sham PKP receiving 1 treatment weekly for 5 weeks or a WLC. WLC's were re-randomised to real or sham after 6 weeks. The main outcome was a change in RMDQ from baseline to end of 5 weeks of real or sham PKP. Results: With an effect size of 0.7 real treatment was significantly different to sham (mean difference RMDQ score = -2.9, p = 0.04, 95% CI -5.8 to -0.1). Compared to WLC, real and sham groups had significant RMDQ improvements (real -9.0, p < 0.01, 95% CI -12.1 to -5.8; effect size 2.1; sham -6.1, p < 0.01, 95% CI -9.1 to -3.1; effect size 1.4). Practitioner empathy (CARE) and patient enablement (PEI) did not predict outcome; holistic health beliefs (CAMBI) did, though. The sham treatment appeared credible; patients did not guess treatment allocation. 3 patients reported minor adverse reactions. Conclusions: Real treatment was significantly different from sham demonstrating a moderate specific effect of PKP; both were better than WLC indicating a substantial non-specific and contextual treatment effect. A larger definitive study would be appropriate with nested qualitative work to help understand the mechanisms involved in PKP.

The Patient Enablement Instrument for Back Pain: Reliability, Content Validity, Construct Validity and Responsiveness

“…This result is supported by the majority (3/4) of previous studies using factor analysis on the original PEI which have also shown unidimensionality [10,11,13,16]. [49]. Lastly with regards to the included hypotheses, we did not find that enablement was related to patients' educational level or the number of previous episodes of LBP.…”

Sham treatment effects in manual therapy trials on back pain patients: a systematic review and pairwise meta-analysis

“…Eight trials were conducted in Europe, 27 28 30 35–39 five in the USA, 24 25 31 40 41 three studies in Brazil, 42–44 one in the UK, 26 Egypt, 32 Japan 45 and Australia. 46 …”

“…Sixteen trials enrolled participants with low back pain (LBP), eight included participants with cervical pain. 26 33 35–37 40–42 …”

“…Participants with experience of the tested treatment were included in eight trials 24 29 31 32 35 37 42 43 and excluded in four. 26 36 39 41 The remaining studies did not provide this information.…”

The patient enablement instrument for back pain: reliability, content validity, construct validity and responsiveness

“…Likewise, Haughney et al found an association between the PEI and improved quality of life for patients with asthma using a modified version of the PEI [ 14 ]. However, a randomised controlled trial on people with chronic back pain by Eardley et al did not show an association between enablement and disability at 5 weeks, potentially indicating a less robust relationship between the PEI and disability (Roland Morris Disability Questionnaire) [ 49 ]. Lastly with regards to the included hypotheses, we did not find that enablement was related to patients’ educational level or the number of previous episodes of LBP.…”