The Evolving Case Supporting Individualised Physiotherapy for Low Back Pain.

Ford Ford,Surkitt Surkitt,Hahne Hahne,Chan Chan,Richards Richards

doi:10.3390/jcm8091334

Abstract

Low-back pain (LBP) is one of the most burdensome health problems in the world. Guidelines recommend simple treatments such as advice that may result in suboptimal outcomes, particularly when applied to people with complex biopsychosocial barriers to recovery. Individualised physiotherapy has the potential of being more effective for people with LBP; however, there is limited evidence supporting this approach. A series of studies supporting the mechanisms underpinning and effectiveness of the Specific Treatment of Problems of the Spine (STOPS) approach to individualised physiotherapy have been published. The clinical and research implications of these findings are presented and discussed. Treatment based on the STOPS approach should also be considered as an approach to individualised physiotherapy in people with LBP.

Highlights

Low-back pain (LBP) is recognised as a common and costly problem in the Western world, with a global prevalence of 0.5 billion, the highest ranking cause of years lived with disability contributing 57·6 million years [1], and an increase in prevalence and disease burden of nearly 20% over the last 10 years [2]
People with LBP have historically been described as having a favourable natural history [3]; systematic reviews of primary care studies show that 28%–79% of people with acute LBP experience persistent or recurrent symptoms at 12 months [4,5]
Based on the scale of the LBP problem, the limited data on treatment effectiveness, and the potential value of individualised treatment, the aim of this paper was to overview the evidence on individualised physiotherapy, including a contextualised presentation and discussion of a series of studies on the Specific Treatment of Problems of the Spine (STOPS) approach

Summary

Introduction

Low-back pain (LBP) is recognised as a common and costly problem in the Western world, with a global prevalence of 0.5 billion, the highest ranking cause of years lived with disability contributing 57·6 million years [1], and an increase in prevalence and disease burden of nearly 20% over the last 10 years [2]. People with LBP have historically been described as having a favourable natural history [3]; systematic reviews of primary care studies show that 28%–79% of people with acute LBP experience persistent or recurrent symptoms at 12 months [4,5]. Syntheses of clinical guidelines suggest international consensus in recommending initial exclusion of red flags and radiculopathy, and subsequent management of LBP as a “non-specific” condition on the basis that a nociceptive cause of symptoms cannot be identified [7,8,9]. The randomised controlled trials (RCTs) upon which guideline recommendations are based typically show small effect sizes of questionable clinical importance [8,9,12]

Objectives

Methods

Findings

Discussion

Conclusion