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Individualised functional restoration plus guideline-based advice vs advice alone for non-reducible discogenic low back pain: a randomised controlled trial.
Physiotherapy. 2017 Jun; 103(2):121-130.P

Abstract

OBJECTIVES

To evaluate the effectiveness of individualised functional restoration plus guideline-based advice compared to advice alone in people with non-reducible discogenic pain (NRDP).

DESIGN

Subgroup analysis within a multicentre, parallel group randomised controlled trial.

SETTING

Fifteen primary care physiotherapy clinics.

PARTICIPANTS

Ninety-six participants with clinical features indicative of NRDP (6 week to 6 month duration of injury).

INTERVENTIONS

Over a 10 week period physiotherapists provided 10 sessions of individualised functional restoration plus guideline-based advice or two sessions of advice alone MAIN OUTCOME MEASURES: Primary outcomes were back and leg pain (separate numerical rating scales) and activity limitation (Oswestry Disability Index).

RESULTS

Between-group differences favoured individualised functional restoration over advice for back pain (1.1, 95% CI 0.1 to 2.1), leg pain (1.5, 95% CI 0.4 to 2.6) and Oswestry (6.3, 95% CI 1.3 to 11.4) at 10 weeks as well as Oswestry at 26 weeks (6.6, 95% CI 1.4 to 11.8). Secondary outcomes and responder analyses also favoured physiotherapy functional restoration suggesting the differences were clinically important.

CONCLUSIONS

In people with NRDP of ≥6 weeks and ≤6 months duration, individualised functional restoration was more effective than advice for all primary outcomes at 10 weeks and sustained at 26 weeks for activity limitation. Our results suggest that for people with NRDP not recovering after 6 weeks, an individualised physiotherapy functional restoration program should be considered. CONTRIBUTION OF PAPER: (1) A physiotherapist delivered functional restoration program individualised to pathoanatomical, psychosocial and neurophysiological barriers and incorporating guideline-based advice was more effective than advice alone in people with non-reducible discogenic low back pain of ≥6 weeks and ≤6 months duration. (2) This trial differs significantly from other studies on individualised physiotherapy, as it investigates a conservative management program that specifically targets the pathoanatomical subgroup non-reducible discogenic pain. ACTRN numbers: ACTRN12609000412235; ACTRN12609000834257.

Authors+Show Affiliations

Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia. Electronic address: alexanderchan54@gmail.com.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia. Electronic address: j.ford@latrobe.edu.au.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia. Electronic address: lukesurkitt@gmail.com.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia. Electronic address: matt.c.richards@gmail.com.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia. Electronic address: slslater@internode.on.net.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia. Electronic address: M.Davidson@latrobe.edu.au.Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia. Electronic address: A.Hahne@latrobe.edu.au.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

27914651

Citation

Chan, Alexander Y P., et al. "Individualised Functional Restoration Plus Guideline-based Advice Vs Advice Alone for Non-reducible Discogenic Low Back Pain: a Randomised Controlled Trial." Physiotherapy, vol. 103, no. 2, 2017, pp. 121-130.
Chan AYP, Ford JJ, Surkitt LD, et al. Individualised functional restoration plus guideline-based advice vs advice alone for non-reducible discogenic low back pain: a randomised controlled trial. Physiotherapy. 2017;103(2):121-130.
Chan, A. Y. P., Ford, J. J., Surkitt, L. D., Richards, M. C., Slater, S. L., Davidson, M., & Hahne, A. J. (2017). Individualised functional restoration plus guideline-based advice vs advice alone for non-reducible discogenic low back pain: a randomised controlled trial. Physiotherapy, 103(2), 121-130. https://doi.org/10.1016/j.physio.2016.08.001
Chan AYP, et al. Individualised Functional Restoration Plus Guideline-based Advice Vs Advice Alone for Non-reducible Discogenic Low Back Pain: a Randomised Controlled Trial. Physiotherapy. 2017;103(2):121-130. PubMed PMID: 27914651.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Individualised functional restoration plus guideline-based advice vs advice alone for non-reducible discogenic low back pain: a randomised controlled trial. AU - Chan,Alexander Y P, AU - Ford,Jon J, AU - Surkitt,Luke D, AU - Richards,Matthew C, AU - Slater,Sarah L, AU - Davidson,Megan, AU - Hahne,Andrew J, Y1 - 2016/08/10/ PY - 2015/12/01/received PY - 2016/08/03/accepted PY - 2016/12/5/pubmed PY - 2018/3/20/medline PY - 2016/12/5/entrez KW - Low back pain KW - Lumbar intervertebral disc KW - Physiotherapy KW - Randomised controlled trial SP - 121 EP - 130 JF - Physiotherapy JO - Physiotherapy VL - 103 IS - 2 N2 - OBJECTIVES: To evaluate the effectiveness of individualised functional restoration plus guideline-based advice compared to advice alone in people with non-reducible discogenic pain (NRDP). DESIGN: Subgroup analysis within a multicentre, parallel group randomised controlled trial. SETTING: Fifteen primary care physiotherapy clinics. PARTICIPANTS: Ninety-six participants with clinical features indicative of NRDP (6 week to 6 month duration of injury). INTERVENTIONS: Over a 10 week period physiotherapists provided 10 sessions of individualised functional restoration plus guideline-based advice or two sessions of advice alone MAIN OUTCOME MEASURES: Primary outcomes were back and leg pain (separate numerical rating scales) and activity limitation (Oswestry Disability Index). RESULTS: Between-group differences favoured individualised functional restoration over advice for back pain (1.1, 95% CI 0.1 to 2.1), leg pain (1.5, 95% CI 0.4 to 2.6) and Oswestry (6.3, 95% CI 1.3 to 11.4) at 10 weeks as well as Oswestry at 26 weeks (6.6, 95% CI 1.4 to 11.8). Secondary outcomes and responder analyses also favoured physiotherapy functional restoration suggesting the differences were clinically important. CONCLUSIONS: In people with NRDP of ≥6 weeks and ≤6 months duration, individualised functional restoration was more effective than advice for all primary outcomes at 10 weeks and sustained at 26 weeks for activity limitation. Our results suggest that for people with NRDP not recovering after 6 weeks, an individualised physiotherapy functional restoration program should be considered. CONTRIBUTION OF PAPER: (1) A physiotherapist delivered functional restoration program individualised to pathoanatomical, psychosocial and neurophysiological barriers and incorporating guideline-based advice was more effective than advice alone in people with non-reducible discogenic low back pain of ≥6 weeks and ≤6 months duration. (2) This trial differs significantly from other studies on individualised physiotherapy, as it investigates a conservative management program that specifically targets the pathoanatomical subgroup non-reducible discogenic pain. ACTRN numbers: ACTRN12609000412235; ACTRN12609000834257. SN - 1873-1465 UR - https://www.unboundmedicine.com/medline/citation/27914651/Individualised_functional_restoration_plus_guideline_based_advice_vs_advice_alone_for_non_reducible_discogenic_low_back_pain:_a_randomised_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0031-9406(16)30043-8 DB - PRIME DP - Unbound Medicine ER -