Lumbar RCT - Classification Guided, as MDT (McKenzie) is a statistically better way to treat lumbar problems MDT is what PTP does, and we do it well, with the highest (& only PT) and second highest credentialed MDT, PTs in NV! Classification-Guided Versus Generalized Postural Intervention in Subgroups of Nonspecific Chronic Low Back Pain A Pragmatic Randomized Controlled Study Liba Sheeran , PhD , * Robert van Deursen , PhD , * Bruce Caterson , PhD , † and Valerie Sparkes , PhD ‡ DOI: 10.1097/BRS.0b013e31829e049b Study Design. Pragmatic randomized controlled single-blinded study. Objective. To compare the effects of the classifi cation system guided postural intervention (CSPI) with generalized postural intervention (GPI) in subgroups of nonspecifi c chronic low back pain (NSCLBP). Summary of Background Data. Spinal motor control impairments and the associated alterations in spinal postures adopted by patients with NSCLBP are highly variable. Research evaluating the effect of interventions that target the specifi c movement/posture impairments in NSCLBP subgroups is therefore warranted. Methods. A total of 49 patients with NSCLBP with a classifi cation of flexion pattern (n = 29) and active extension pattern (n = 20) control impairment were recruited from a large cohort study and randomly assigned into CSPI and GPI. The primary outcome was change in Roland-Morris Disability Questionnaire, secondary outcomes were change in pain visual analogue scale, spinal repositioning sense including thoracic and lumbar absolute error, variable error, constant error, and trunk muscle activity during sitting and standing. The intervention was evaluated at baseline, immediately post one-to-one intervention and post 4-week home-based training. Results. The CSPI produced statistically and clinically signifi cant reduction in disability (4.2 [95% CI, 2.9–5.3]) and pain (2, [95% CI, 1.3–2.6]) compared with minimal change in the GPI disability (0.4, [95% CI, − 0.8 to 1.6]) and pain ( − 0.2, [95% CI, − 0.5 to 0.9]). Repeated measures analysis of variance revealed that CSPI significantly reduced absolute error in thoracic (sitting) and lumbar spine (standing) and constant error in lumbar spine (standing) post one-to-one phase, although this was no longer significant at 4 weeks. Neither intervention had an effect on trunk muscle activity. Conclusion. Compared with minimal change in the GPI group, the CSPI produced statistically and clinically signifi cant improvements in disability and pain outcomes and short-term improvements in some parameters of spinal repositioning sense in NSCLBP subgroups. Key words: nonspecific chronic low back pain , classificationguided intervention , posture , RMDQ , VAS , thoracic and lumbar repositioning error , spinal wheel , sEMG . Level of Evidence: 2 Spine 2013;38:1613–1625
Posted on: Tue, 22 Oct 2013 20:00:53 +0000
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