Abstract
BackgroundSystematic reviews have shown that exercise therapy and spinal manipulation are both more effective for low back pain (LBP) than no treatment at all. However, the effects are at best modest. To enhance the clinical outcomes, recommendations are to improve the patient selection process, and to identify relevant subgroups to guide clinical decision-making. One of the systems that has potentials to improve clinical decision-making is a treatment-based classification system that is intended to identify those patients who are most likely to respond to direction-specific exercises, manipulation, or stabilisation exercises.Methods/DesignThe primary aim of this randomised controlled trial will be to assess the effectiveness of a classification-based system. A sample of 150 patients with subacute and chronic LBP who attend a private physical therapy clinic for treatment will be recruited. At baseline, all participants will undergo a standard evaluation by trained research physical therapists and will be classified into one of the following subgroups: direction-specific exercises, manipulation, or stabilisation. The patient will not be informed about the results of the examination. Patients will be randomly assigned to classification-based treatment or usual care according to the Dutch LBP guidelines, and will complete questionnaires at baseline, and 8, 26, and 52 weeks after the start of the treatment. The primary outcomes will be general perceived recovery, functional status, and pain intensity. Alongside this trial, an economic evaluation of cost-effectiveness and cost-utility will be conducted from a societal perspective.DiscussionThe present study will contribute to our knowledge about the effectiveness and cost-effectiveness of classification-based treatment in patients with LBP.Trial registrationTrial registration number: NTR1176
Highlights
Systematic reviews have shown that exercise therapy and spinal manipulation are both more effective for low back pain (LBP) than no treatment at all
The present study will contribute to our knowledge about the effectiveness and cost-effectiveness of classification-based treatment in patients with LBP
The present study will focus on a revised version of the Delitto et al treatment-based classification system [8], based on updated evidence outlined in previous randomised controlled trials (RCTs) [25], but is consistent with the concept that sub-groups of patients can be identified, and that the primary subgroups are patients who are likely to respond to direction-specific exercises, stabilisation or manipulation
Summary
Systematic reviews have shown that exercise therapy and spinal manipulation are both more effective for low back pain (LBP) than no treatment at all. One of the systems that has potentials to improve clinical decisionmaking is a treatment-based classification system that is intended to identify those patients who are most likely to respond to direction-specific exercises, manipulation, or stabilisation exercises. Low back pain (LBP) is a common condition. The lack of a clear patho-anatomical stated that additional etiological, diagnostic, and prognostic studies are needed to identify varieties of LBP, natural courses, or more homogeneous subgroups of patients with LBP [5]. Many attempts have been made to classify patients with LBP into more homogeneous subgroups, based on the specific interventions that they are likely to respond to. The majority of the classification systems was based on a judgemental approach, relying on clinical experience and intuition, and a minority was based on a statistical approach and prospective study designs
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
