Abstract
Objectives: To compare selected physical and bio-behavioral improvements following McKenzie intervention in individuals with discogenic chronic low back pain (CLBP) demonstrating centralization and partial centralization of pain. Design: Prospective cohort study with three assessments; at base line and two follow-ups. Setting: Two out-patient orthopedic Physical Therapy clinics. Participants: 105 volunteers with CLBP (52 men and 53women) average ages 41.9 and 37.1 years. Methods: Subjects filled out pain and related fear and disability questionnaires, performed selected physical tests then underwent a McKenzie assessment protocol. McKenzie assessment protocol utilizes directional preference exercises to determine the pain centralization-phenomenon. Subjects were divided into 2-groups; completely centralized group (CCG) and partially centralized group (PCG), and underwent a McKenzie intervention. Outcome measurements were repeated at the end of the 5th and 10th weeks after completing the treatment Outcome Measurements: Pain related fear and disability beliefs were assessed using the Fear Avoidance Belief Questionnaires (FABQ) and Disability Belief Questionnaire (DBQ). The time of sit-to-stand, forward bending, and customary and fast walking was recorded. Pain (anticipated vs. actual perception), were measured before and after each physical task. Descriptive statistics, Chi-square, paired t-tests, repeated measures ANOVA were used for longitudinal comparisons across assessment intervals at p<0.05 level. Results: Significant improvements in patient physical performance times and bio-behavioral variables were observed on the 5th week following the intervention, but tended to regress thereafter. Conclusions: In this cohort study of CLBP both CCG and PCG patients demonstrated significant measurable improvements in physical performances that remained stable for 10 weeks as a result of improved pain and related fear and disability beliefs.
Highlights
It is typical for an individual with acute low back pain, to avoid physical activities associated with pain and discomfort, the persistence of avoidance behaviors beyond the expected healing time when little or no pain exists represent a complex challenge to health care practitioners [1,2,3].Numerous bio-behavioral factors including psychosocial, cognitive, environmental and physiological factors influence the pain experience
Significant improvements in patient physical performance times and bio-behavioral variables were observed on the 5th week following the intervention, but tended to regress thereafter
In this cohort study of chronic low back pain (CLBP) both completely centralized group (CCG) and partially centralized group (PCG) patients demonstrated significant measurable improvements in physical performances that remained stable for 10 weeks as a result of improved pain and related fear and disability beliefs
Summary
Numerous bio-behavioral factors including psychosocial, cognitive, environmental and physiological factors influence the pain experience These factors intermediate between the neurophysiological aspect of pain and the actual sensory perception of pain, which may attenuate or exacerbate the discrepancy among pathology, actual pain, impairment, functional disability and eventually lead to chronic low back pain (CLBP) [2,4,5,6,7]. Cognitive factors such as anticipation of pain and pain related fear beliefs, as well as perception of self-disability are among the strongest predictors of poor functional performances that reinforce the persistence of avoidance behaviors [4,5,6,7,8,9]. The model determines whether a person will become an “avoider” and experience persistence disability or become “a confronter” and resume previously avoided physical activities [4-
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