Tags

Type your tag names separated by a space and hit enter

Who Benefits Most From Individualized Physiotherapy or Advice for Low Back Disorders? A Preplanned Effect Modifier Analysis of a Randomized Controlled Trial.
Spine (Phila Pa 1976). 2017 Nov 01; 42(21):E1215-E1224.S

Abstract

STUDY DESIGN

A preplanned effect modifier analysis of the Specific Treatment of Problems of the Spine randomized controlled trial.

OBJECTIVE

To identify characteristics associated with larger or smaller treatment effects in people with low back disorders undergoing either individualized physical therapy or guideline-based advice.

SUMMARY OF BACKGROUND DATA

Identifying subgroups of people who attain a larger or smaller benefit from particular treatments has been identified as a high research priority for low back disorders.

METHODS

The trial involved 300 participants with low back pain and/or referred leg pain (≥6 wk, ≤6 mo duration), who satisfied criteria to be classified into five subgroups (with 228 participants classified into three subgroups relating to disc-related disorders, and 64 classified into the zygapophyseal joint dysfunction subgroup). Participants were randomly allocated to receive either two sessions of guideline based advice (n = 144), or 10 sessions of individualized physical therapy targeting pathoanatomical, psychosocial, and neurophysiological factors (n = 156). Univariate and multivariate linear mixed models determined the interaction between treatment group and potential effect modifiers (defined a priori) for the primary outcomes of back pain, leg pain (0-10 Numeric Rating Scale) and activity limitation (Oswestry Disability Index) over a 52-week follow-up.

RESULTS

Participants with higher levels of back pain, higher Örebro scores (indicative of higher risk of persistent pain) or longer duration of symptoms derived the largest benefits from individualized physical therapy relative to advice. Poorer coping also predicted larger benefits from individualized physical therapy in the univariate analysis.

CONCLUSION

These findings suggest that people with low back disorders could be preferentially targeted for individualized physical therapy rather than advice if they have higher back pain levels, longer duration of symptoms, or higher Örebro scores.

LEVEL OF EVIDENCE

2.

Authors+Show Affiliations

Low Back Research Team, School of Allied Health, La Trobe University, Melbourne, Australia.Low Back Research Team, School of Allied Health, La Trobe University, Melbourne, Australia.Low Back Research Team, School of Allied Health, La Trobe University, Melbourne, Australia.Low Back Research Team, School of Allied Health, La Trobe University, Melbourne, Australia.Low Back Research Team, School of Allied Health, La Trobe University, Melbourne, Australia.Physiotherapy Department, Northern Health, Melbourne, Australia.Low Back Research Team, School of Allied Health, La Trobe University, Melbourne, Australia.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

28263227

Citation

Hahne, Andrew J., et al. "Who Benefits Most From Individualized Physiotherapy or Advice for Low Back Disorders? a Preplanned Effect Modifier Analysis of a Randomized Controlled Trial." Spine, vol. 42, no. 21, 2017, pp. E1215-E1224.
Hahne AJ, Ford JJ, Richards MC, et al. Who Benefits Most From Individualized Physiotherapy or Advice for Low Back Disorders? A Preplanned Effect Modifier Analysis of a Randomized Controlled Trial. Spine (Phila Pa 1976). 2017;42(21):E1215-E1224.
Hahne, A. J., Ford, J. J., Richards, M. C., Surkitt, L. D., Chan, A. Y. P., Slater, S. L., & Taylor, N. F. (2017). Who Benefits Most From Individualized Physiotherapy or Advice for Low Back Disorders? A Preplanned Effect Modifier Analysis of a Randomized Controlled Trial. Spine, 42(21), E1215-E1224. https://doi.org/10.1097/BRS.0000000000002148
Hahne AJ, et al. Who Benefits Most From Individualized Physiotherapy or Advice for Low Back Disorders? a Preplanned Effect Modifier Analysis of a Randomized Controlled Trial. Spine (Phila Pa 1976). 2017 Nov 1;42(21):E1215-E1224. PubMed PMID: 28263227.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Who Benefits Most From Individualized Physiotherapy or Advice for Low Back Disorders? A Preplanned Effect Modifier Analysis of a Randomized Controlled Trial. AU - Hahne,Andrew J, AU - Ford,Jon J, AU - Richards,Matthew C, AU - Surkitt,Luke D, AU - Chan,Alexander Y P, AU - Slater,Sarah L, AU - Taylor,Nicholas F, PY - 2017/3/7/pubmed PY - 2019/6/5/medline PY - 2017/3/7/entrez SP - E1215 EP - E1224 JF - Spine JO - Spine (Phila Pa 1976) VL - 42 IS - 21 N2 - STUDY DESIGN: A preplanned effect modifier analysis of the Specific Treatment of Problems of the Spine randomized controlled trial. OBJECTIVE: To identify characteristics associated with larger or smaller treatment effects in people with low back disorders undergoing either individualized physical therapy or guideline-based advice. SUMMARY OF BACKGROUND DATA: Identifying subgroups of people who attain a larger or smaller benefit from particular treatments has been identified as a high research priority for low back disorders. METHODS: The trial involved 300 participants with low back pain and/or referred leg pain (≥6 wk, ≤6 mo duration), who satisfied criteria to be classified into five subgroups (with 228 participants classified into three subgroups relating to disc-related disorders, and 64 classified into the zygapophyseal joint dysfunction subgroup). Participants were randomly allocated to receive either two sessions of guideline based advice (n = 144), or 10 sessions of individualized physical therapy targeting pathoanatomical, psychosocial, and neurophysiological factors (n = 156). Univariate and multivariate linear mixed models determined the interaction between treatment group and potential effect modifiers (defined a priori) for the primary outcomes of back pain, leg pain (0-10 Numeric Rating Scale) and activity limitation (Oswestry Disability Index) over a 52-week follow-up. RESULTS: Participants with higher levels of back pain, higher Örebro scores (indicative of higher risk of persistent pain) or longer duration of symptoms derived the largest benefits from individualized physical therapy relative to advice. Poorer coping also predicted larger benefits from individualized physical therapy in the univariate analysis. CONCLUSION: These findings suggest that people with low back disorders could be preferentially targeted for individualized physical therapy rather than advice if they have higher back pain levels, longer duration of symptoms, or higher Örebro scores. LEVEL OF EVIDENCE: 2. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/28263227/Who_Benefits_Most_From_Individualized_Physiotherapy_or_Advice_for_Low_Back_Disorders_A_Preplanned_Effect_Modifier_Analysis_of_a_Randomized_Controlled_Trial_ L2 - https://doi.org/10.1097/BRS.0000000000002148 DB - PRIME DP - Unbound Medicine ER -