Abstract
BackgroundLow back pain is a highly prevalent and disabling condition worldwide. Clinical guidelines for the management of patients with acute low back pain recommend first-line treatment consisting of advice, reassurance and simple analgesics. Exercise is also commonly prescribed to these patients. The primary aim of this study was to evaluate the short-term effect of adding the McKenzie method to the first-line care of patients with acute low back pain.MethodsA multi-centre randomized controlled trial with a 3-month follow-up was conducted between September 2005 and June 2008. Patients seeking care for acute non-specific low back pain from primary care medical practices were screened. Eligible participants were assigned to receive a treatment programme based on the McKenzie method and first-line care (advice, reassurance and time-contingent acetaminophen) or first-line care alone, for 3 weeks. Primary outcome measures included pain (0-10 Numeric Rating Scale) over the first seven days, pain at 1 week, pain at 3 weeks and global perceived effect (-5 to 5 scale) at 3 weeks. Treatment effects were estimated using linear mixed models.ResultsOne hundred and forty-eight participants were randomized into study groups, of whom 138 (93%) completed the last follow-up. The addition of the McKenzie method to first-line care produced statistically significant but small reductions in pain when compared to first-line care alone: mean of -0.4 points (95% confidence interval, -0.8 to -0.1) at 1 week, -0.7 points (95% confidence interval, -1.2 to -0.1) at 3 weeks, and -0.3 points (95% confidence interval, -0.5 to -0.0) over the first 7 days. Patients receiving the McKenzie method did not show additional effects on global perceived effect, disability, function or on the risk of persistent symptoms. These patients sought less additional health care than those receiving only first-line care (P = 0.002).ConclusionsWhen added to the currently recommended first-line care of acute low back pain, a treatment programme based on the McKenzie method does not produce appreciable additional short-term improvements in pain, disability, function or global perceived effect. However, the McKenzie method seems to reduce health utilization although it does not reduce patient's risk of developing persistent symptoms.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12605000032651
Highlights
Low back pain is a highly prevalent and disabling condition worldwide
Current clinical guidelines [1,2,3] recommend the provision of advice, reassurance and simple analgesics as first-line treatment for patients with acute low back pain consulting a primary care physician
Both were subsequently ruled ineligible to participate in the trial and, were considered legitimate post-randomization exclusions [32]
Summary
Low back pain is a highly prevalent and disabling condition worldwide. Clinical guidelines for the management of patients with acute low back pain recommend first-line treatment consisting of advice, reassurance and simple analgesics. Current clinical guidelines [1,2,3] recommend the provision of advice, reassurance and simple analgesics as first-line treatment for patients with acute low back pain consulting a primary care physician. Proponents of exercise therapy argue that better results would be obtained if exercises were customized to a patient’s clinical presentation [8,9,10,11] This treatment rationale forms the basis of the McKenzie method [12,13], which consists of a system of classification and classificationbased treatment that is commonly used to treat low back pain in many countries and in the USA [14] and Europe [15,16,17]
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