Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up

Cecchi, Francesca; Molino-Lova, Raffaele; Chiti, M.; Pasquini, Guido; Paperini, Anita; Conti, Andrea A.; Macchi, Claudio

doi:10.1177/0269215509342328

Cited by 77 publications

(93 citation statements)

References 26 publications

(32 reference statements)

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“…1, 190 Several authors have described restricted hip mobility in patients with low back pain as an indicator of positive response to interventions targeting the hip. 33,44, 53,84,184,284,278,289 Some early evidence demonstrates successful incorporation of interventions targeting the hip into a more comprehensive treatment program for patients with lumbar spinal stenosis. 278,279 Though research in this area is developing, clinicians may consider including examination of the hip and interventions targeting identified hip impairments for patients with LBP.…”

Section: Clinical Guidelines: Interventionsmentioning

confidence: 99%

Low Back Pain

Delitto¹,

George²,

Dillen³

et al. 2012

J Orthop Sports Phys Ther

776

352

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Section: Clinical Guidelines: Interventionsmentioning

confidence: 99%

Low Back Pain

Delitto¹,

George²,

Dillen³

et al. 2012

J Orthop Sports Phys Ther

776

352

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“…29 Followup was for 12 months; the primary study outcomes were the Roland-Morris Disability Questionnaire score and secondary outcomes were pain, pain recurrence, further back pain treatment, and sick leave. Although change in pain (SMD = 5.32; 95% CI: 4.61-6.04) and function (SMD = 2.32; 95% CI: 1.89-2.76) favored the SMT group ( Table 2 and Figures 3 and 4), further treatment for LBP during the follow-up period was signifi cantly more frequent in the SMT group.…”

Section: Subgroups and Cost-effectivenessmentioning

confidence: 99%

Comparative Effectiveness of Exercise, Acupuncture, and Spinal Manipulation for Low Back Pain

Standaert

Friedly

Erwin

et al. 2011

Spine

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Structured exercise and SMT appear to offer equivalent benefits in the management of pain and function for patients with nonspecific chronic LBP. If no clinical benefit is appreciated after using one of these approaches for 8 weeks, then the treatment plan should be reevaluated and consideration should be given to modifying the treatment approach or using alternate forms of care. Strength of recommendation: Weak.There is insufficient evidence regarding the relative benefits of the acupuncture compared with either structured exercise or SMT in the treatment of chronic LBP.There is insufficient evidence to address differential effects of structured exercise, SMT, or acupuncture for specific subgroups of individuals with chronic LBP. There is insufficient evidence regarding the relative cost-effectiveness of structured exercise, SMT, or acupuncture in the treatment of chronic LBP.

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“… Sometimes it was not clear from methods that subgroups analyses were going to be performed; they were just presented in the results 62,69,74,80  All papers measured subgroups of interest prior to randomisation, with most using adequate measurements 45,48,61, 72,75, 77  Four studies reported only the interaction effect sizes with confidence intervals 46,58,59, 82  Eight studies reported the p-values only 37,50,66,67,69, 83,86,88  Nine papers did not report either the interaction effect sizes or confidence intervals or p-values. 49, 60, 62-65, 68, 70, 71  Four studies reported subgroup analyses within individual subgroups rather than between group interaction.…”

mentioning

confidence: 99%

Identifying back pain subgroups: developing and applying approaches using individual patient data collected within clinical trials

Patel

Hee

Mistry

et al. 2016

Programme Grants Appl Res

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Total word count including appendix: 93,499 ii ABSTRACT BackgroundThere is good evidence that therapist delivered interventions have modest beneficial effects for people with low back pain (LBP). Identification of subgroups of people with LBP who may benefit from these different treatment approaches is an important research priority. Aim and objectivesOverall aim was to improve the clinical and cost-effectiveness of LBP treatment by providing patients, their clinical advisors, and health service purchasers with better information about which participants are most likely to benefit from which treatment To achieve these objectives required substantial methodological work including the development and evaluation of some novel statistical approaches. This programme of work was not designed to analyse main effect of interventions and no such interpretations should be made.iii MethodsFirstly, we reviewed the literature on treatment moderators and subgroups. We initially invited investigators of trials of therapist-delivered interventions for LBP with >179 participants to share their data with us; some further smaller trials offered to us were also included. Using these trials we developed a repository of individual participant data of therapist delivered interventions for LBP. Using this dataset we sought to identify which participant characteristics, if any, predict response to different treatments (moderators) for clinical and cost effectiveness outcomes.We did an ANCOVA to identify potential moderators to apply in our main analyses.Subsequently we developed and applied three methods of subgroup identification; recursive partitioning (interaction trees and subgroup identification based on a differential effect search), adaptive risk group refinement, and an individual participant data indirect network meta-analysis to identify sub-groups defined by multiple parameters. ResultsWe included data from 19 randomised controlled trials with 9,328 participants (mean age 49 years, 57% females). Our prespecified analyses using recursive partitioning and adaptive risk group refinement performed well and allowed us to identify some subgroups. The differences in the effect size in the different subgroups were typically small, and unlikely to be clinically meaningful. Increasing baseline severity on the outcome of interest was the strongest driver of sub-group identification that we identified. Additionally we explored the application of Bayesian indirect network metaanalysis. This method produced varying probabilities that a particular treatment choice would be most likely to be effective for a specific patient profile. ConclusionThese data lack clinical or cost-effectiveness justification for the use of baseline characteristics in the development of subgroups for back pain. The methodological developments from this work have the potential to be applied in other clinical areas.iv The pooled repository database will serve as a valuable resource to the LBP research community. FundingFunding from the NIHR Programme Grants for Ap...

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Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up

Abstract: Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.

Cited by 77 publications

References 26 publications

Low Back Pain

Low Back Pain

Comparative Effectiveness of Exercise, Acupuncture, and Spinal Manipulation for Low Back Pain

Identifying back pain subgroups: developing and applying approaches using individual patient data collected within clinical trials

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