Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule: Study protocol of a randomized clinical trial [NCT00257998

Kornelia Kulig,John D Childs,Julie M Fritz,Joshua A Cleland

doi:10.1186/1471-2474-7-11

Abstract

BackgroundRecently a clinical prediction rule (CPR) has been developed and validated that accurately identifies patients with low back pain (LBP) that are likely to benefit from a lumbo-pelvic thrust manipulation. The studies that developed and validated the rule used the identical manipulation procedure. However, recent evidence suggests that different manual therapy techniques may result similar outcomes. The purpose of this study is to investigate the effectiveness of three different manual therapy techniques in a subgroup of patient with low back pain that satisfy the CPR.Methods/DesignConsecutive patients with LBP referred to physical therapy clinics in one of four geographical locations who satisfy the CPR will be invited to participate in this randomized clinical trial. Subjects who agree to participate will undergo a standard evaluation and complete a number of patient self-report questionnaires including the Oswestry Disability Index (OSW), which will serve as the primary outcome measure. Following the baseline examination patients will be randomly assigned to receive the lumbopelvic manipulation used in the development of the CPR, an alternative lumbar manipulation technique, or non-thrust lumbar mobilization technique for the first 2 visits. Beginning on visit 3, all 3 groups will receive an identical standard exercise program for 3 visits (visits 3,4,5). Outcomes of interest will be captured by a therapist blind to group assignment at 1 week (3rd visit), 4 weeks (6th visit) and at a 6-month follow-up. The primary aim of the study will be tested with analysis of variance (ANOVA) using the change in OSW score from baseline to 4-weeks (OSWBaseline – OSW4-weeks) as the dependent variable. The independent variable will be treatment with three levels (lumbo-pelvic manipulation, alternative lumbar manipulation, lumbar mobilization).DiscussionThis trial will be the first to investigate the effectiveness of various manual therapy techniques for patients with LBP who satisfy a CPR.

Highlights

A clinical prediction rule (CPR) has been developed and validated that accurately identifies patients with low back pain (LBP) that are likely to benefit from a lumbo-pelvic thrust manipulation
This trial will be the first to investigate the effectiveness of various manual therapy techniques for patients with LBP who satisfy a CPR
The disparity in the results of clinical trials may be partly attributable to the admission of all patients with LBP without an attempt to a priori identify those likely to benefit from the intervention

Summary

Introduction

A clinical prediction rule (CPR) has been developed and validated that accurately identifies patients with low back pain (LBP) that are likely to benefit from a lumbo-pelvic thrust manipulation. A few randomized trials have found manipulation to be more beneficial for a sub-group of patients with more acute symptoms [14,15], or more limited straight leg raise range of motion [16]. Each of these studies was published in 1990 or before, and none sought to develop a multifactorial classification rule that would maximize the prediction of success with manipulation prior to the intervention

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