ALEXANDRIA, Va., Dec. 21 /PRNewswire/ -- A patient's status on a clinical prediction rule for low back pain indicates the likelihood of successful outcome from spinal manipulation treatment, according to a study recently published this month in the Annals of Internal Medicine.
Physical therapist Maj John D Childs, PT, PhD, of Wilford Hall Medical Center, Lackland Air Force Base, Texas, and other physical therapist researchers have validated a clinical prediction rule that determined the likelihood that a patient with low back pain will benefit from spinal manipulation. Factors in the prediction rule include symptom duration, symptom location, fear-avoidance beliefs, lumbar mobility, and hip rotation range of motion. The best results were from those patients who were positive on the rule, defined as meeting at least 4 out of 5 criteria. To view an online instructional video on the prediction rule, please go to http://www.apta.org/Foundation/news/spinal_manipulation
"Attempts to identify effective interventions for individuals with low back pain have been largely unsuccessful, especially where spinal manipulation is concerned," Childs explained. "Conflicting conclusions may be attributable to the failure of researchers to adequately consider the importance of classification. Developing methods for matching patients with low back pain to treatments that are most likely to benefit them is an important research priority."
The study examined 131 patients with low back pain, 18 to 60 years of age, who were referred to care provided by physical therapists. Patients were randomly assigned to receive physical therapy that included two sessions of high-velocity thrust spinal manipulation plus an exercise program (manipulation group) or an exercise program without spinal manipulation (exercise group). During the first two sessions, patients in the manipulation group received high-velocity thrust spinal manipulation and a range-of-motion exercise only. Patients in the exercise group (and patients in the manipulation group after the first two sessions of high-velocity thrust manipulation) were treated with a low-stress aerobic and lumbar spine- strengthening program. Patients in both groups attended physical therapy twice during the first week and then once a week for the next 3 weeks, for a total of five sessions.
Significantly greater improvements in pain and disability were observed after 1 and 4 weeks of treatment among patients receiving physical therapy that included spinal manipulation compared with patients receiving an exercise program without manipulation. At the 6-month follow-up, patients who did not receive spinal manipulation demonstrated statistically significantly greater use of medication, health care utilization, and lost time from work due to back pain than did patients in the manipulation group. Results indicated that a patient who is positive on the rule and treated with spinal manipulation has a 92% chance of achieving a successful outcome by the end of one week. "A patient's status on the rule was of little relevance in determining the outcome of patients treated with the exercise intervention," Childs said, supporting the notion that the rule is specifically predicting a response to spinal manipulation. "The results of this study mean that physical therapists can have increased confidence in using the rule to identify patients with low back pain who are good candidates for spinal manipulation."
Because patients with chronic, disabling low back pain account for a disproportionate share of health care expenditures and workers' compensation costs, the potential cost savings of an early, effective intervention to prevent individuals from progressing to chronic disability may be considerable.
In this study, having symptoms for less than 16 days was the most accurate individual predictor. However, only 35% of patients (46 of 131) had symptoms for less than 16 days. "In support of previous evidence demonstrating the value of early access to physical therapist services, the results of this study also emphasize the need for early access to physical therapy intervention in the rehabilitation of patients with low back pain," Childs said.
Childs was funded in part by the Foundation for Physical Therapy, which was established in 1979 as a national, independent nonprofit corporation dedicated to the ultimate goal of improving the quality and delivery of patient care. The Foundation accomplishes this goal by providing support for scientifically based and clinically relevant physical therapy research.
Contributions to the Foundation for Physical Therapy are tax-deductible and can be made via check (payable to "Foundation for Physical Therapy") or credit card.
American Physical Therapy AssociationCONTACT: Jennifer Rondon of American Physical Therapy Association,+1-703-706-3216
