Part 2 of Blog Series Investigating Clinical Research Regarding 2 Common Low Back Pain Treatment Methods

Long, A., Donelson, R., Fung, T. (2004) conducted a multicentered randomized controlled trial which investigated treatment for 312 patients with acute, subacute, and chronic low back pain and sciatica who demonstrate a direction of preference consistent with MDT during their initial evaluation.

Acute back pain was defined as less than 7 days, subacute as less than 7 weeks, and chronic as greater than 7 weeks. The majority of patients reported having at least 1 previous episode of low back pain. The patients who demonstrate direction of preference were then randomly assigned to 1 of 3 of treatment groups in order to compare the effects of performing McKenzie exercises consistent with the patient’s demonstrated direction of preference, McKenzie exercises opposite from the patient’s demonstrated direction of preference, and core stabilization exercises of multidirectional midrange lumbar exercises with stretches for hip and thigh muscles.

The 3 treatment groups were allowed a minimum of 3 visits and a maximum of 6 visits over a period of 2 weeks. leg symptoms, with or without one neurological sign, age between 18 and 65 years, and demonstration of directional preference during the mechanical assessment.

Exclusion criteria for the study include cauda equina, 2 or more neurological signs, spinal fractures, post-surgical, off work for 1 year or more due to low back pain, medical causes (examples include severe osteoporosis, and inflammatory or infectious conditions), uncontrolled medical conditions (including diabetes, angina, and hypertension), pregnancy, no directional preference demonstrated during initial evaluation, as well as patients who had prior knowledge of, or specific physician referral for, the McKenzie method of diagnosis and treatment; visual analogue scale, disability as indicated by the 24 item Roland Morris Disability Questionnaire, medication use in total number of pills taken daily, pain location and neurologic symptoms using the Quebec Task Force severity rating on a 1-4 scale, degree of recovery, depression using the 21 item Beck Depression Inventory, and 0-5 rating of home and work activity interference. preference.

These directions were 191 (83%) extension, 16 (7%) flexion, 23 (10%) lateral. 24 patients who demonstrated a direction of preference for extension experienced positive results only after their pelvis was offset from midline prior to prone extension.

All 3 treatment groups (McKenzie exercises consistent with the patient’s demonstrated direction of preference, McKenzie exercises opposite from the patient’s demonstrated direction of preference, and core stabilization exercises of multidirectional midrange lumbar exercises with stretches for hip and thigh muscles) demonstrated improvement in all outcome measures after 2 weeks.

Statistically significantly greater improvement (p-values ranging 0.016 to p<0.001) was achieved by the group which performed McKenzie exercises consistent with the patient’s demonstrated direction of preference, as measured by all outcome variables. causes” which includes examples of severe osteoporosis, and inflammatory or infectious conditions, as well as the exclusion category of “uncontrolled medical conditions” with examples of this including diabetes, angina, and hypertension.

Furthermore, patients were excluded for the factors of pregnancy, no directional preference demonstrated during initial evaluation, and patients with prior knowledge of, or specific physician referral for, the McKenzie method of diagnosis and treatment. These relatively extensive exclusion criteria limit the clinical applicability of the result because patients often present with one or more of these factors in addition to low back pain.

Another limitation is that 29 subjects (12.6%) dropped out from the study and did not provide data at 2 weeks. A total of 201 subjects (68%) returned compliance questionnaires, making analysis of this crucial variable less accurate. Additionally, subjects were blinded from their diagnosed direction of preference, however the MDT trained PTs were not blinded as to which treatment group the patient was placed into. This created a potential for the PTs to demonstrate bias during their interaction with the patients. Lastly, the core stabilization exercises in this article were not described in great detail, which limits the replicability of the study.

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