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Predicting response to motor control exercises and graded activity for patients with low back pain

MACEDO LG; MAHER CG; HANCOCK MJ; KAMPER SJ; MCAULEY JH; STANTON TR; STAFFORD R; HODGES PW
PHYS THER , 2014, vol. 94, n° 11, p. 1543-1554
Doc n°: 172026
Localisation : Documentation IRR

D.O.I. : http://dx.doi.org/DOI:10.2522/ptj.20140014
Descripteurs : CE51 - LOMBALGIE

Current treatments for low back pain have small effects. A research
priority is to identify patient characteristics associated with larger effects
for specific interventions.
The aim of this study was to identify
simple clinical characteristics of patients with chronic low back pain who would
benefit more from either motor control exercises or graded activity. This
study was a secondary analysis of the results of a randomized controlled trial.
METHODS: One hundred seventy-two patients with chronic low back pain were
enrolled in the trial, which was conducted in Australian physical therapy
clinics. The treatment consisted of 12 initial exercise sessions over an 8-week
period and booster sessions at 4 and 10 months following randomization. The
putative effect modifiers (psychosocial features, physical activity level,
walking tolerance, and self-reported signs of clinical instability) were measured
at baseline. Measures of pain and function (both measured on a 0-10 scale) were
taken at baseline and at 2, 6, and 12 months by a blinded assessor. RESULTS:
Self-reported clinical instability was a statistically significant and clinically
important modifier of treatment response for 12-month function (interaction:
2.72; 95% confidence interval=1.39 to 4.06). Participants with high scores on the
clinical instability questionnaire (>/=9) did 0.76 points better with motor
control exercises, whereas those who had low scores (<9) did 1.93 points better
with graded activity. Most other effect modifiers investigated did not appear to
be useful in identifying preferential response to exercise type. LIMITATIONS: The
psychometric properties of the instability questionnaire have not been fully
tested. CONCLUSIONS:
A simple 15-item questionnaire of features considered
indicative of clinical instability can identify patients who respond best to
either motor control exercises or graded activity.
CI - (c) 2014 American Physical Therapy Association.

Langue : ANGLAIS

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