Randomized trial of two physiotherapy interventions for primary care neck and back pain patients: 'McKenzie' vs brief physiotherapy pain management

Moffett, Jennifer Klaber; Jackson, David A.; Gardiner, Eric; Torgerson, David; Coulton, Simon; Eaton, Sharyn; Mooney, M. P.; Pickering, Carolyn; Green, A. J.; Walker, Leslie G.; May, Stephen; Young, Steve

doi:10.1093/rheumatology/kel339

Cited by 75 publications

(31 citation statements)

References 37 publications

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“…Although data was generated from a single centre, comparison with data from other primary care studies suggests that the participants in our study are representative of the patients with back pain in primary care [7,41]. The measurement of the impact of cultural differences on change scores is limited by the relative size of the ethnic groups who demonstrated little benefit, predominantly those who classified themselves as being from North African, Chinese or Middle Eastern countries.…”

Section: Discussionmentioning

confidence: 99%

Low back pain: what determines functional outcome at six months? An observational study

Harms

Peers

Chase

2010

BMC Musculoskelet Disord

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BackgroundThe rise in disability due to back pain has been exponential with escalating medical and societal costs. The relative contribution of individual prognostic indicators to the pattern of recovery remains unclear. The objective of this study was to determine the prognostic value of demographic, psychosocial, employment and clinical factors on outcome in patients with low back painMethodsA prospective cohort study with six-month follow-up was undertaken at a multidisciplinary back pain clinic in central London employing physiotherapists, osteopaths, clinical psychologists and physicians, receiving referrals from 123 general practitioners. Over a twelve-month period, 593 consecutive patients referred from general practice with simple low back pain were recruited. A baseline questionnaire was developed to elicit information on potential prognostic variables. The primary outcome measures were change in 24-item Roland Morris disability questionnaire score at six months as a measure of low back related functional disability and the physical functioning scale of the SF-36, adjusted for baseline scores.ResultsRoland Morris scores improved by 3.8 index points (95% confidence interval 3.23 to 4.32) at six months and SF-36 physical functioning score by 10.7 points (95% confidence interval 8.36 to 12.95). Ten factors were linked to outcome yet in a multiple regression model only two remained predictive. Those with episodic rather than continuous pain were more likely to have recovered at six months (odds ratio 2.64 confidence interval 1.25 to 5.60), while those that classified themselves as non-white were less likely to have recovered (0.41 confidence interval 0.18 to 0.96).ConclusionsAnalysis controlling for confounding variables, demonstrated that participants showed greater improvement if their episodes of pain during the previous year were short-lived while those with Middle Eastern, North African and Chinese ethnicity demonstrated minimal improvement. The study did not support previous findings that a wide range of factors could predict outcome.

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Section: Discussionmentioning

confidence: 99%

Low back pain: what determines functional outcome at six months? An observational study

Harms

Peers

Chase

2010

BMC Musculoskelet Disord

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“…They will have had neck pain for at least 3 months, which fits with current thinking on what constitutes ‘chronic’ neck pain, [1] such that outcome data at this time point will be consistent with that in systematic reviews [24,25]. Given that patients are likely to have disability as well as pain, we will have a 28% minimum cut-off score on the Northwick Park Questionnaire (NPQ), based on the cut-off at 10 points (out of 36), the same as we used in our physiotherapy trial [26]. We will exclude patients with: serious underlying pathology; prior cervical spine surgery; history of psychosis; rheumatoid arthritis ankylosing spondylitis; osteoporosis; haemophilia; cancer; HIV or hepatitis; alcohol or drug dependency currently or in the last 12 months; actively pursuing compensation or with pending litigation; currently receiving acupuncture for neck pain; or having attended one-to-one Alexander Technique lessons in the last 24 months.…”

Section: Methodsmentioning

confidence: 99%

Alexander Technique Lessons, Acupuncture Sessions or usual care for patients with chronic neck pain (ATLAS): study protocol for a randomised controlled trial

MacPherson

Tilbrook

Richmond

et al. 2013

Trials

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BackgroundChronic neck pain is a common condition in the adult population. More research is needed to evaluate interventions aiming to facilitate beneficial long-term change. We propose to evaluate the effect of Alexander Technique lessons and acupuncture in a rigorously conducted pragmatic trial with an embedded qualitative study.Methods/DesignWe will recruit 500 patients who have been diagnosed with neck pain in primary care, who have continued to experience neck pain for at least three months with 28% minimum cut-off score on the Northwick Park Neck Pain Questionnaire (NPQ). We will exclude patients with serious underlying pathology, prior cervical spine surgery, history of psychosis, rheumatoid arthritis, ankylosing spondylitis, osteoporosis, haemophilia, cancer, HIV or hepatitis, or with alcohol or drug dependency currently or in the last 12 months, or actively pursuing compensation or with pending litigation.The York Trials Unit will randomly allocate participants using a secure computer-based system. We will use block randomisation with allocation to each intervention arm being unambiguously concealed from anyone who might subvert the randomisation process.Participants will be randomised in equal proportions to Alexander Technique lessons, acupuncture or usual care alone. Twenty 30-minute Alexander Technique lessons will be provided by teachers registered with the Society of Teachers of the Alexander Technique and twelve 50-minute sessions of acupuncture will be provided by acupuncturists registered with the British Acupuncture Council. All participants will continue to receive usual GP care.The primary outcome will be the NPQ at 12 months, with the secondary time point at 6 months, and an area-under-curve analysis will include 3, 6 and 12 month time-points. Adverse events will be documented. Potential intervention effect modifiers and mediators to be explored include: self-efficacy, stress management, and the incorporation of practitioner advice about self-care and lifestyle. Qualitative material will be used to address issues of safety, acceptability and factors that impact on longer term outcomes.DiscussionThis study will provide robust evidence on whether there are significant clinical benefits to patients, economic benefits demonstrating value for money, and sufficient levels of acceptability and safety.Trial registrationCurrent Controlled Trials ISRCTN15186354

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“…There was no difference when continuous traction was compared to placebo (3 RCTs, 606 participants) [71, 95, 96] for improving pain or function in patients with acute to chronic neck pain in the short term.…”

Section: Evidence Of No Benefit (Vs Control) or No Difference (Vs Anomentioning

confidence: 99%

An ICON Overview on Physical Modalities for Neck Pain and Associated Disorders

Graham

Gross²,

Carlesso³

et al. 2013

TOORTHJ

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Introduction: Neck pain is common, can be disabling and is costly to society. Physical modalities are often included in neck rehabilitation programs. Interventions may include thermal, electrotherapy, ultrasound, mechanical traction, laser and acupuncture. Definitive knowledge regarding optimal modalities and dosage for neck pain management is limited.Purpose: To systematically review existing literature to establish the evidence-base for recommendations on physical modalities for acute to chronic neck pain.Methods:A comprehensive computerized and manual search strategy from January 2000 to July 2012, systematic review methodological quality assessment using AMSTAR, qualitative assessment using a GRADE approach and recommendation presentation was included. Systematic or meta-analyses of studies evaluating physical modalities were eligible. Independent assessment by at least two review team members was conducted. Data extraction was performed by one reviewer and checked by a second. Disagreements were resolved by consensus.Results:Of 103 reviews eligible, 20 were included and 83 were excluded. Short term pain relief - Moderate evidence of benefit: acupuncture, intermittent traction and laser were shown to be better than placebo for chronic neck pain. Moderate evidence of no benefit: pulsed ultrasound, infrared light or continuous traction was no better than placebo for acute whiplash associated disorder, chronic myofascial neck pain or subacute to chronic neck pain. There was no added benefit when hot packs were combined with mobilization, manipulation or electrical muscle stimulation for chronic neck pain, function or patient satisfaction at six month follow-up.Conclusions:The current state of the evidence favours acupuncture, laser and intermittent traction for chronic neck pain. Some electrotherapies show little benefit for chronic neck pain. Consistent dosage, improved design and long term follow-up continue to be the recommendations for future research.

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Randomized trial of two physiotherapy interventions for primary care neck and back pain patients: 'McKenzie' vs brief physiotherapy pain management

Abstract: The McK approach resulted in higher patient satisfaction overall but the SFA could be more cost-effective, as fewer (three vs four) sessions were needed.

Cited by 75 publications

References 37 publications

Low back pain: what determines functional outcome at six months? An observational study

Low back pain: what determines functional outcome at six months? An observational study

Alexander Technique Lessons, Acupuncture Sessions or usual care for patients with chronic neck pain (ATLAS): study protocol for a randomised controlled trial

An ICON Overview on Physical Modalities for Neck Pain and Associated Disorders

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