BACKGROUND: Recent studies on chronic low back pain (cLBP) rehabilitation suggest that predictors of treatment outcome may be differ according to the considered conservative treatment. AIM: To identify predictors of response to back school (BS), individual physiotherapy (IP) or spinal manipulation (SM) for cLBP. POPULATION:outpatients with cLBP. SETTING:Outpatient rehabilitation department. DESIGN: Retrospective analysis from a randomized trial. METHODS: Two hundred and ten patients with cLBP were randomly assigned to either BS, IP or SM; the Roland Morris Disability Questionnaire (RM) was assessed before and after treatment: those who decreased their RM score <2.5 were considered non-responders. Baseline potential predictors of outcome included demographics, general and cLBP history, life satisfaction. RESULTS: Of the 205 patients who completed treatment (140/205 women, age 58+14 years), non-responders were 72 (34.2%). SM showed the highest functional improvement and the lowest non-response rate. In a multivariable logistic regression, lower baseline RM score (OR 0.82, 95% CI 0.76-0.89, P<0.001) and received treatment (OR 0.32, 95% CI 0.21-0.50, P<0.001) were independent predictors of non-response. Being in the lowest tertile of baseline RM score (<6) predicted non response to treatment for BS and IP, but not for SM (same risk for all tertiles). CONCLUSION:In our patients with cLBP lower baseline pain-related disability predicted non-response to physiotherapy, but not to spinal manipulation. CLINICAL REHABILITATION IMPACT:. Our results suggest that, independent form other characteristics, patients with cLBP and low pain-related disability should first consider spinal manipulation as a conservative treatment.

Predictors of functional outcome in patients with chronic low back pain undergoing back school, individual physiotherapy or spinal manipulation / F. Cecchi, S. NEGRINI, G. Pasquini, A. Paperini, A.A. Conti, M. Chiti, F. Zaina, C. Macchi, R. Molino Lova. - In: EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE. - ISSN 1973-9087. - 48:3(2012), pp. 371-378.

Predictors of functional outcome in patients with chronic low back pain undergoing back school, individual physiotherapy or spinal manipulation

S. NEGRINI;R. Molino Lova
2012

Abstract

BACKGROUND: Recent studies on chronic low back pain (cLBP) rehabilitation suggest that predictors of treatment outcome may be differ according to the considered conservative treatment. AIM: To identify predictors of response to back school (BS), individual physiotherapy (IP) or spinal manipulation (SM) for cLBP. POPULATION:outpatients with cLBP. SETTING:Outpatient rehabilitation department. DESIGN: Retrospective analysis from a randomized trial. METHODS: Two hundred and ten patients with cLBP were randomly assigned to either BS, IP or SM; the Roland Morris Disability Questionnaire (RM) was assessed before and after treatment: those who decreased their RM score <2.5 were considered non-responders. Baseline potential predictors of outcome included demographics, general and cLBP history, life satisfaction. RESULTS: Of the 205 patients who completed treatment (140/205 women, age 58+14 years), non-responders were 72 (34.2%). SM showed the highest functional improvement and the lowest non-response rate. In a multivariable logistic regression, lower baseline RM score (OR 0.82, 95% CI 0.76-0.89, P<0.001) and received treatment (OR 0.32, 95% CI 0.21-0.50, P<0.001) were independent predictors of non-response. Being in the lowest tertile of baseline RM score (<6) predicted non response to treatment for BS and IP, but not for SM (same risk for all tertiles). CONCLUSION:In our patients with cLBP lower baseline pain-related disability predicted non-response to physiotherapy, but not to spinal manipulation. CLINICAL REHABILITATION IMPACT:. Our results suggest that, independent form other characteristics, patients with cLBP and low pain-related disability should first consider spinal manipulation as a conservative treatment.
Low back pain; Manipulation, spinal; Exercise
Settore MED/34 - Medicina Fisica e Riabilitativa
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/721651
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