News Author: Laurie Barclay, MD

March 29, 2006 — Matching therapy to type of low back pain (LBP) improves outcome, according to the results of a randomized trial reported in the March 15 issue of Spine.

"Despite concentrated research efforts, few interventions have been identified as effective for patients with acute LBP," write Gerard P. Brennan, PhD, PT, from the Rehab Agency Intermountain Health Care in Salt Lake City, Utah, and colleagues. "One explanation offered for the failure to identify effective treatments is the lack of methods for subgrouping, or classifying, patients with 'nonspecific' LBP in a manner that would help direct treatment decision-making."

Before starting treatment, the investigators examined 123 patients with LBP of less than 90 days' duration who were referred to physical therapy. They classified the patients into 3 subgroups based on the type of treatment thought most likely to benefit the patient (manipulation, stabilization exercise, or specific exercise) and then randomized them to receive one of these treatments for 4 weeks. Using the Oswestry, the investigators assessed short-term (4 weeks) and long-term (1 year) disability. Patients receiving treatment matched to their subgroup were compared with those receiving unmatched treatment.

Mean age was 37.7 ± 10.7 years, and 45% were female. Patients receiving matched treatments had greater short- and long-term reductions in disability than did those receiving unmatched treatments. After 4 weeks, the difference favoring the matched treatment group was 6.6 Oswestry points (95% confidence interval [CI], 0.70 - 12.5). At long-term follow-up, this difference was 8.3 points (95% CI, 2.5 - 14.1). Analysis of long-term outcomes for only those patients who complied with therapy yielded a similar result.

"Nonspecific low back pain should not be viewed as a homogenous condition," the authors write. "Outcomes can be improved when subgrouping is used to guide treatment decision-making."

Study limitations include incomplete long-term follow-up; more female patients receiving unmatched treatment; and lack of generalizability to patients with more mild disability, more chronic symptoms, or signs of nerve root compression.

"Given the increasing likelihood of persistent disability among patients who fail to recover quickly, the initial treatment phase may be the 'window of opportunity" for clinicians," the authors write. "Improved decision-making through subgrouping during the initial treatment phase may therefore have important long-term consequences."

The Deseret Foundation supported this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.