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Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial.
Spine (Phila Pa 1976). 2003 Jul 01; 28(13):1363-71; discussion 1372.S

Abstract

STUDY DESIGN

A randomized clinical trial was conducted.

OBJECTIVE

To compare the effectiveness of classification-based physical therapy with that of therapy based on clinical practice guidelines for patients with acute, work-related low back pain.

SUMMARY OF BACKGROUND DATA

Clinical practice guidelines recommend minimal intervention during the first few weeks after acute low back injury. However, studies supporting this recommendation have not attempted to identify which patients are likely to respond to particular interventions.

METHODS

For this study, 78 subjects with work-related low back pain of less than 3 weeks duration were randomized to receive therapy based on a classification system that attempts to match patients to specific interventions or therapy based on the Agency for Health Care Policy and Research guidelines. The subjects were followed for 1 year. Outcomes included the impairment index, Oswestry scale, SF-36 component scores, satisfaction, medical costs, and return to work status.

RESULTS

After adjustment for baseline factors, subjects receiving classification-based therapy showed greater change on the Oswestry (P = 0.023) and the SF-36 physical component (P = 0.029) after 4 weeks. Patient satisfaction was greater (P = 0.006) and return to full-duty work status more likely (P = 0.017) after 4 weeks in the classification-based group. After 1 year, there was a trend toward reduced Oswestry scores in the classification-based group (P = 0.063). Median total medical costs for 1 year after injury were 1003.68 dollars for the guideline-based group and 774.00 dollars for the classification-based group (P = 0.13).

CONCLUSIONS

For patients with acute, work-related low back pain, the use of a classification-based approach resulted in improved disability and return to work status after 4 weeks, as compared with therapy based on clinical practice guidelines. Further research is needed on the optimal timing and methods of intervention for patients with acute low back pain.

Authors+Show Affiliations

Department of Physical Therapy, University of Pittsburgh, PA 15260, USA. jfritz@pitt.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12838091

Citation

Fritz, Julie M., et al. "Comparison of Classification-based Physical Therapy With Therapy Based On Clinical Practice Guidelines for Patients With Acute Low Back Pain: a Randomized Clinical Trial." Spine, vol. 28, no. 13, 2003, pp. 1363-71; discussion 1372.
Fritz JM, Delitto A, Erhard RE. Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial. Spine (Phila Pa 1976). 2003;28(13):1363-71; discussion 1372.
Fritz, J. M., Delitto, A., & Erhard, R. E. (2003). Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial. Spine, 28(13), 1363-71; discussion 1372.
Fritz JM, Delitto A, Erhard RE. Comparison of Classification-based Physical Therapy With Therapy Based On Clinical Practice Guidelines for Patients With Acute Low Back Pain: a Randomized Clinical Trial. Spine (Phila Pa 1976). 2003 Jul 1;28(13):1363-71; discussion 1372. PubMed PMID: 12838091.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial. AU - Fritz,Julie M, AU - Delitto,Anthony, AU - Erhard,Richard E, PY - 2003/7/3/pubmed PY - 2004/2/26/medline PY - 2003/7/3/entrez SP - 1363-71; discussion 1372 JF - Spine JO - Spine (Phila Pa 1976) VL - 28 IS - 13 N2 - STUDY DESIGN: A randomized clinical trial was conducted. OBJECTIVE: To compare the effectiveness of classification-based physical therapy with that of therapy based on clinical practice guidelines for patients with acute, work-related low back pain. SUMMARY OF BACKGROUND DATA: Clinical practice guidelines recommend minimal intervention during the first few weeks after acute low back injury. However, studies supporting this recommendation have not attempted to identify which patients are likely to respond to particular interventions. METHODS: For this study, 78 subjects with work-related low back pain of less than 3 weeks duration were randomized to receive therapy based on a classification system that attempts to match patients to specific interventions or therapy based on the Agency for Health Care Policy and Research guidelines. The subjects were followed for 1 year. Outcomes included the impairment index, Oswestry scale, SF-36 component scores, satisfaction, medical costs, and return to work status. RESULTS: After adjustment for baseline factors, subjects receiving classification-based therapy showed greater change on the Oswestry (P = 0.023) and the SF-36 physical component (P = 0.029) after 4 weeks. Patient satisfaction was greater (P = 0.006) and return to full-duty work status more likely (P = 0.017) after 4 weeks in the classification-based group. After 1 year, there was a trend toward reduced Oswestry scores in the classification-based group (P = 0.063). Median total medical costs for 1 year after injury were 1003.68 dollars for the guideline-based group and 774.00 dollars for the classification-based group (P = 0.13). CONCLUSIONS: For patients with acute, work-related low back pain, the use of a classification-based approach resulted in improved disability and return to work status after 4 weeks, as compared with therapy based on clinical practice guidelines. Further research is needed on the optimal timing and methods of intervention for patients with acute low back pain. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/12838091/Comparison_of_classification_based_physical_therapy_with_therapy_based_on_clinical_practice_guidelines_for_patients_with_acute_low_back_pain:_a_randomized_clinical_trial_ L2 - https://doi.org/10.1097/01.BRS.0000067115.61673.FF DB - PRIME DP - Unbound Medicine ER -