Tags

Type your tag names separated by a space and hit enter

Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial.
Br J Sports Med. 2016 Feb; 50(4):237-45.BJ

Abstract

BACKGROUND

Many patients with low-back disorders persisting beyond 6 weeks do not recover. This study investigates whether individualised physiotherapy plus guideline-based advice results in superior outcomes to advice alone in participants with low-back disorders.

METHODS

This prospective parallel group multicentre randomised controlled trial was set in 16 primary care physiotherapy practices in Melbourne, Australia. Random assignment resulted in 156 participants receiving 10 sessions of physiotherapy that was individualised based on pathoanatomical, psychosocial and neurophysiological barriers to recovery combined with guideline-based advice, and 144 participants receiving 2 sessions of physiotherapist-delivered advice alone. Primary outcomes were activity limitation (Oswestry Disability Index) and numerical rating scales for back and leg pain at 5, 10, 26 and 52 weeks postbaseline. Analyses were by intention-to-treat using linear mixed models.

RESULTS

Between-group differences showed significant effects favouring individualised physiotherapy for back and leg pain at 10 weeks (back: 1.3, 95% CI 0.8 to 1.8; leg: 1.1, 95% CI 0.5 to 1.7) and 26 weeks (back: 0.9, 95% CI 0.4 to 1.4; leg: 1.0, 95% CI 0.4 to 1.6). Oswestry favoured individualised physiotherapy at 10 weeks (4.7; 95% CI 2.0 to 7.5), 26 weeks (5.4; 95% CI 2.6 to 8.2) and 52 weeks (4.3; 95% CI 1.4 to 7.1). Responder analysis at 52 weeks showed participants receiving individualised physiotherapy were more likely to improve by a clinically important amount of 50% from baseline for Oswestry (relative risk (RR=1.3) 1.5; 95% CI 1.2 to 1.8) and back pain (RR 1.3; 95% CI 1.2 to 1.8) than participants receiving advice alone.

CONCLUSIONS

10 sessions of individualised physiotherapy was more effective than 2 sessions of advice alone in participants with low-back disorders of ≥6 weeks and ≤6 months duration. Between-group changes were sustained at 12 months for activity limitation and 6 months for back and leg pain and were likely to be clinically significant.

CLINICAL TRIAL REGISTRATION

ACTRN12609000834257.

Authors+Show Affiliations

Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia.School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

26486585

Citation

Ford, Jon J., et al. "Individualised Physiotherapy as an Adjunct to Guideline-based Advice for Low Back Disorders in Primary Care: a Randomised Controlled Trial." British Journal of Sports Medicine, vol. 50, no. 4, 2016, pp. 237-45.
Ford JJ, Hahne AJ, Surkitt LD, et al. Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial. Br J Sports Med. 2016;50(4):237-45.
Ford, J. J., Hahne, A. J., Surkitt, L. D., Chan, A. Y., Richards, M. C., Slater, S. L., Hinman, R. S., Pizzari, T., Davidson, M., & Taylor, N. F. (2016). Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial. British Journal of Sports Medicine, 50(4), 237-45. https://doi.org/10.1136/bjsports-2015-095058
Ford JJ, et al. Individualised Physiotherapy as an Adjunct to Guideline-based Advice for Low Back Disorders in Primary Care: a Randomised Controlled Trial. Br J Sports Med. 2016;50(4):237-45. PubMed PMID: 26486585.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial. AU - Ford,Jon J, AU - Hahne,Andrew J, AU - Surkitt,Luke D, AU - Chan,Alexander Y P, AU - Richards,Matthew C, AU - Slater,Sarah L, AU - Hinman,Rana S, AU - Pizzari,Tania, AU - Davidson,Megan, AU - Taylor,Nicholas F, Y1 - 2015/10/20/ PY - 2015/10/01/accepted PY - 2015/10/22/entrez PY - 2015/10/22/pubmed PY - 2016/11/1/medline KW - Physiotherapy KW - Randomised controlled trial SP - 237 EP - 45 JF - British journal of sports medicine JO - Br J Sports Med VL - 50 IS - 4 N2 - BACKGROUND: Many patients with low-back disorders persisting beyond 6 weeks do not recover. This study investigates whether individualised physiotherapy plus guideline-based advice results in superior outcomes to advice alone in participants with low-back disorders. METHODS: This prospective parallel group multicentre randomised controlled trial was set in 16 primary care physiotherapy practices in Melbourne, Australia. Random assignment resulted in 156 participants receiving 10 sessions of physiotherapy that was individualised based on pathoanatomical, psychosocial and neurophysiological barriers to recovery combined with guideline-based advice, and 144 participants receiving 2 sessions of physiotherapist-delivered advice alone. Primary outcomes were activity limitation (Oswestry Disability Index) and numerical rating scales for back and leg pain at 5, 10, 26 and 52 weeks postbaseline. Analyses were by intention-to-treat using linear mixed models. RESULTS: Between-group differences showed significant effects favouring individualised physiotherapy for back and leg pain at 10 weeks (back: 1.3, 95% CI 0.8 to 1.8; leg: 1.1, 95% CI 0.5 to 1.7) and 26 weeks (back: 0.9, 95% CI 0.4 to 1.4; leg: 1.0, 95% CI 0.4 to 1.6). Oswestry favoured individualised physiotherapy at 10 weeks (4.7; 95% CI 2.0 to 7.5), 26 weeks (5.4; 95% CI 2.6 to 8.2) and 52 weeks (4.3; 95% CI 1.4 to 7.1). Responder analysis at 52 weeks showed participants receiving individualised physiotherapy were more likely to improve by a clinically important amount of 50% from baseline for Oswestry (relative risk (RR=1.3) 1.5; 95% CI 1.2 to 1.8) and back pain (RR 1.3; 95% CI 1.2 to 1.8) than participants receiving advice alone. CONCLUSIONS: 10 sessions of individualised physiotherapy was more effective than 2 sessions of advice alone in participants with low-back disorders of ≥6 weeks and ≤6 months duration. Between-group changes were sustained at 12 months for activity limitation and 6 months for back and leg pain and were likely to be clinically significant. CLINICAL TRIAL REGISTRATION: ACTRN12609000834257. SN - 1473-0480 UR - https://www.unboundmedicine.com/medline/citation/26486585/Individualised_physiotherapy_as_an_adjunct_to_guideline_based_advice_for_low_back_disorders_in_primary_care:_a_randomised_controlled_trial_ L2 - https://bjsm.bmj.com/lookup/pmidlookup?view=long&pmid=26486585 DB - PRIME DP - Unbound Medicine ER -