Benefit of specific vs general exercise for low back pain with movement control impairment .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2016;4(17):11 BMC Musculoskelet Disord. 2016 Mar 22;17(1):13570 patients with sub-acute low back pain (LBP) and movement control impairment were randomized to receive either specific movement control exercise or general exercise (control) in combination with manual therapy. The purpose of this study was to determine if there is a significant difference in clinical outcomes between general and specified therapies for improving disability. The findings of this study indicated a significantly greater improvement in disability form baseline, assessed by the Roland-Morris Disability Questionnaire, and significantly less need for pain medications in the specific movement control exercise group compared to the control group after 12 months. Patient-specific functional scale scores demonstrated a significantly greater improvement from baseline values in the specific movement control exercise group compared to the Control group at 12 months, but not at 3 months. The Oswestry Disability Index, need for other treatment methods, the number of absences from work, and patient satisfaction were comparable between groups.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
4/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
Low back pain is a common disorder in the general population that can often lead to disability and a decreased quality of life. The etiology of low back pain varies greatly and frequently results in unidentifiable pain symptoms. It is often recommended that patients with low back pain be divided into sub-groups as guided by the O'Sullivan system to allow for tailored treatment. One such subgroup is movement control impairment, which is characterized by patients that provoke pain through maladaptive physical compensation. While sub-acute low back pain is traditionally managed with exercise regimens, there is limited evidence evaluating the comparative effectiveness of general and specific exercise treatments for low back pain patients with movement control impairment, thus warranting the present study.
¿Cuál era la pregunta principal de la investigación?
In the treatment of sub-acute low back pain with movement control impairment, is there a difference between general and specific exercise therapy when assessed over a 12-month period using pain, function, and disability outcome measures?
- Significantly greater improvement in change from baseline was reported in the specific movement control exercise group compared to the Control group for the Roland-Morris Disability Questionnaire at 3 months (-2.4 [95% CI -4.5, -1.1]; p<0.01) and 12 months (-1.7 [95% CI -3.9, -0.5]; p<0.01)
- Both groups demonstrated a significant improvement from baseline on the Patient-specific functional scale, however, no significant difference in the change from baseline was reported between treatment groups at 3 months (p=0.13). At 12 months a significantly greater improvement in change from baseline was reported in the specific movement control exercise group compared to the Control group (3.1 [95% CI 0.2, 6.0]; p=0.03)
- Both groups significantly improved from baseline on the Oswestry Disability Index; however, no significant differences in change from baseline were reported between treatment groups for the Oswestry Disability Index at 3 months (p=0.35) or at 12 months (p=0.35)
- Pain medication was needed significantly less in the specific movement control exercise group compared to the control group at 12 months
- No significant differences were reported between groups for the number of absences from work, need for other treatments, or patient satisfaction
¿Qué es lo que más debo recordar?
In the treatment of recurring low back pain with movement control impairment, the use of a specific movement control exercise regimen was associated with significantly greater reduction disability scores from baseline and a reduced need for medication when compared to a general exercise regimen at 3 and 12 months. Additionally, a significantly greater improvement from baseline in the patient-specific functional scale was observed in the specific movement control exercise group at 12 months. The Oswestry Disability Index, the number of absence from work, need for other treatment modalities, and patient satisfaction remained similar between groups throughout the study duration.
¿Cómo afectará esto al cuidado de mis pacientes?
The findings of this study suggest that specific movement control exercise in combination with manual therapy may provide a more beneficial outcome compared to general exercise programs for patients with sub-acute LBP and movement control impairment. Future trials should compare the benefits of specific movement control exercise with various other types of general exercise programs to confirm the specific efficacy of this treatment modality in this patient population.
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