TY - JOUR
T1 - Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial
AU - Van Dillen, Linda R.
AU - Norton, Barbara J.
AU - Sahrmann, Shirley A.
AU - Evanoff, Bradley A.
AU - Harris-Hayes, Marcie
AU - Holtzman, Gregory W.
AU - Earley, Jeanne
AU - Chou, Irene
AU - Strube, Michael J.
N1 - Funding Information:
Our study was a 2-parallel group, 2-center, prospective, single blind, randomized clinical trial in people with chronic LBP. Duration of treatment was 6 weeks; data were collected before and immediately after treatment, and 6 and 12 months later. Recruitment spanned February 2007 through August 2009. Final follow-up outcomes were collected in October 2011. The study events are in Fig. 1 . The trial was funded by grant R01 HD047709 from the National Institute of Child Health and Human Development. The protocol used for the trial was approved by the Human Research Protection Office at Washington University School of Medicint (IRB #: 201107034). The trial ended upon attainment of all of the 12 month outcomes. There were no changes to the trial design after commencement of the study. The trial was registered on Clinicaltrials.gov (NCT00802724).
Publisher Copyright:
© 2016 Elsevier Ltd.
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Background: It is unknown if low back pain (LBP) outcomes are enhanced by classification-specific treatment based on the Movement System Impairment classification system. The moderating effect of adherence to treatment also is unknown. Objectives: Compare the efficacy of a classification-specific treatment (CS) and a non classification-specific (NCs) treatment and examine the moderating effect of adherence on outcomes. Design: 2 center, 2 parallel group, prospective, randomized, clinical trial. Method: Participants with chronic LBP were classified and randomized. Self-report data was obtained at baseline, post-treatment, and 6 and 12 months post-treatment. The primary outcome was the modified Oswestry Disability Index (mODI; 0-100%). Treatment effect modifiers were exercise adherence and performance training adherence. An intention to treat approach and hierarchical linear modeling were used. Results: 47 people received CS treatment, 54 people received NCs treatment. Treatment groups did not differ in mODI scores (p > 0.05). For both groups, scores improved with treatment (p < 0.05), plateaued at 6 months (p > 0.05), and minimally regressed at 12 months (p < 0.05). Performance training adherence had a unique, independent effect on mODI scores above and beyond the effect of exercise adherence (p < 0.05). There were no treatment group effects on the relationship between mODI scores and the two types of adherence (p < 0.05). Conclusions: There were no differences in function between the two treatment groups (CS and NCs). In both treatment groups, people with chronic LBP displayed clinically important long-term improvements in function. When both forms of adherence were considered, the improvements were uniquely related to adherence to performance training.
AB - Background: It is unknown if low back pain (LBP) outcomes are enhanced by classification-specific treatment based on the Movement System Impairment classification system. The moderating effect of adherence to treatment also is unknown. Objectives: Compare the efficacy of a classification-specific treatment (CS) and a non classification-specific (NCs) treatment and examine the moderating effect of adherence on outcomes. Design: 2 center, 2 parallel group, prospective, randomized, clinical trial. Method: Participants with chronic LBP were classified and randomized. Self-report data was obtained at baseline, post-treatment, and 6 and 12 months post-treatment. The primary outcome was the modified Oswestry Disability Index (mODI; 0-100%). Treatment effect modifiers were exercise adherence and performance training adherence. An intention to treat approach and hierarchical linear modeling were used. Results: 47 people received CS treatment, 54 people received NCs treatment. Treatment groups did not differ in mODI scores (p > 0.05). For both groups, scores improved with treatment (p < 0.05), plateaued at 6 months (p > 0.05), and minimally regressed at 12 months (p < 0.05). Performance training adherence had a unique, independent effect on mODI scores above and beyond the effect of exercise adherence (p < 0.05). There were no treatment group effects on the relationship between mODI scores and the two types of adherence (p < 0.05). Conclusions: There were no differences in function between the two treatment groups (CS and NCs). In both treatment groups, people with chronic LBP displayed clinically important long-term improvements in function. When both forms of adherence were considered, the improvements were uniquely related to adherence to performance training.
KW - Adherence
KW - Classification
KW - Low back pain
UR - http://www.scopus.com/inward/record.url?scp=84973155151&partnerID=8YFLogxK
U2 - 10.1016/j.math.2016.04.003
DO - 10.1016/j.math.2016.04.003
M3 - Article
C2 - 27317505
AN - SCOPUS:84973155151
SN - 1356-689X
VL - 24
SP - 52
EP - 64
JO - Manual Therapy
JF - Manual Therapy
ER -