Abstract
Physiotherapists commonly use post-treatment changes in a patient's pain intensity and range of motion to guide treatment selection and predict possible longer-term outcomes. This study tested the validity of this practice by evaluating the predictive value of within-session changes in pain intensity and range of motion in 53 patients with low back pain. Pain intensity and range of motion measurements of spinal flexion, extension, lateral flexion, and straight-leg-raise were taken by the patient's therapist before and after one treatment session, and were repeated by a blinded therapist at the beginning of the patient's subsequent treatment session. Regression analysis revealed that the strength of association between within-session and between-session changes ranged from r = 0.35 to r = 0.80 for range of motion measurements, and from r = 0.24 to r = 0.47 for pain intensity. Odds ratios for pain and range of motion ranged from 3.5 (95% CI 0.9 to 14.6) to 37.0 (95% CI 4.1 to 330), indicating greater odds of improving between-session if improvement was obtained within-session. These results provide preliminary support for the practice of using within-session changes in pain intensity and range of motion to guide treatment selection when treating impairments in patients with low back pain.
Highlights
A challenge facing clinicians is the selection of treatment for patients with low back pain
The main objective of this study was to determine the utility of within-session changes in pain intensity and range of motion for predicting between-session changes in patients with low back pain
This provided a test of the validity of using within-session changes to guide selection of treatments intended to reduce pain or improve impairments in range of motion
Summary
A challenge facing clinicians is the selection of treatment for patients with low back pain. Patient management models based on pathology are not always helpful in treatment selection as it is estimated that a specific diagnosis can be made for only 15% of patients with low back pain (Cherkin 1998, Waddell 1998). Compounding this uncertainty is the lack of scientific evidence to support particular treatment approaches for patients with low back pain (Foster 1998, Skargren and Oberg 1998). Maitland advocated administering a treatment technique and immediately reassessing the patient’s symptoms and signs to evaluate the treatment’s potential effectiveness. Maitland described these principles with reference to peripheral (Maitland 1991) and vertebral (Maitland 1986) joints, their application to low back pain is
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