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BMC Musculoskeletal Disorders

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Open Access 01-12-2007 | Research article

The effectiveness of motorised lumbar traction in the management of LBP with lumbo sacral nerve root involvement: a feasibility study

Authors: Annette A Harte, George D Baxter, Jacqueline H Gracey

Published in: BMC Musculoskeletal Disorders | Issue 1/2007

Abstract

Background

Traction is commonly used for the treatment of low back pain (LBP), predominately with nerve root involvement; however its benefits remain to be established. The aim of this study was to test the feasibility of a pragmatic randomized controlled trial to compare the difference between two treatment protocols (manual therapy, exercise and advice, with or without traction) in the management of acute/sub acute LBP with 'nerve root' involvement.

Methods

30 LBP patients with nerve root pain were recruited and randomly assigned to one of two treatment groups. Primary outcome measures were the: McGill pain questionnaire, Roland Morris disability questionnaire, and the SF36 Questionnaire; recorded at baseline, discharge, 3 and 6 months post-discharge.

Results

27 patients completed treatment with a loss of another four patients at follow up. Intention to treat analysis demonstrated an improvement in all outcomes at follow up points but there appeared to be little difference between the groups.

Conclusion

This study has shown that a trial recruiting patients with 'nerve root' problems is feasible. Further research based upon a fully powered trial is required to ascertain if the addition of traction has any benefit in the management of these patients.

Trial Registration

Registration number: ISRCTN78417198

Available only for authorised users

van Tulder MW, Becker A, Bekkering T, Breen A, Carter T, del Real MT, Hutchinson A, Koes B, Kryger-Baggesen P, Laerum E, Malmivaara A, Nachemson A, Niehus W, Roux E, Rozenberg S: European guidelines for the management of acute nonspecific low back pain in primary care. 2004, European Commission, Research Directorate General. COST B13 Working group, [http://www.backpaineurope.org]

Clarke JA, van Tulder MW, Bloomberg SEI, de Vet HCW, van der Heijden GJMG, Bronfort G: Traction for low back pain with or without sciatica. The Cochrane Database of Systematic Reviews. 2005, CD003010-10.1002/1461858.cd003010.PUB3. 4

Harte AA, Gracey JH, Baxter GD: Current use of lumbar traction in the management of low back pain: Results of a survey of physiotherapists in the United Kingdom. Arch Phys Med Rehabil. 2005, 86 (6): 1164-1169. 10.1016/j.apmr.2004.11.040.PubMed

Bell RG, Rothman RH: The conservative treatment of sciatica. Spine. 1984, 9: 54-56. 10.1097/00007632-198401000-00012.PubMed

Waddell G: The back pain revolution. 1998, Edinburgh. Churchill Livingstone

Beauvais C, Wybier M, Chazerain P, Harboun M, Liote F, Roucoules J, Koeger AC, Bellaiche L, Orcel P, Bardin T, Ziza J, Laredo JD: Prognostic value of early computed tomography in radiculopathy due to lumber intervertebral disk herniation: A prospective study. Joint Bone Spine. 2003, 70: 134-139. 10.1016/S1297-319X(03)00021-6.PubMed

CSAG (Clinical Standards Advisory Group): Back pain: Report of a CSAG Committee on Back Pain. chaired by Professor Michael Rosen. 1994, London. HMSO

Waddell G, McIntosh A, Hutchinson A, Feder G, Lewis M: Low back pain evidence review. 1999, London. Royal College of General Practitioners

Koes BW, van Tulder MW, Ostelo R, Burton AK, Waddell G: Clinical guidelines for the management of low back pain in primary care. An international comparison. Spine. 2001, 26: 2504-2514. 10.1097/00007632-200111150-00022.PubMed

10.

Vroomen PCAJ, de Krom MCTFM, Slofstra PD, Knottnerus JA: Conservative Treatment of sciatica: A systematic review. Journal of Spinal Disorders. 2000, 13: 463-469. 10.1097/00002517-200012000-00001.PubMed

11.

Grieve GP: Common vertebral joint problems. 1981, Edinburgh. Churchill Livingstone

12.

Deyo RA, Rainville J, Kent DL: The rational clinical examination: What can the history and physical examination tell us about LBP?. JAMA. 1992, 268: 760-765. 10.1001/jama.268.6.760.PubMed

13.

Weber H, Holme I, Amlie E: The natural course of acute sciatica with nerve root problems in a double-blind placebo-controlled trial evaluating the effect of piroxicam. Spine. 1993, 18: 1433-8. 10.1097/00007632-199312000-00021.PubMed

14.

Pocock SJ: Clinical trials. A practical approach. 1983, Wiley and Sons, Chichester

15.

Melzack R: The McGill pain questionnaire: Major properties and scoring methods. Pain. 1975, 1: 277-299. 10.1016/0304-3959(75)90044-5.PubMed

16.

Holroyd KA, Holm JE, Keefe FJ, Turner JA, Bradley LA, Murphy WD, Johnston P, Anderson K, Hinkle AL, O'Malley WB: A multi-centre evaluation of the McGill Pain Questionnaire: results from more than 1700 chronic pain patients. Pain. 1992, 48: 301-311. 10.1016/0304-3959(92)90077-O.PubMed

17.

Clark W, Fletcher J, Janal M, Carroll D: Hierarchical clustering of pain and emotion descriptors: towards a revision of the McGill Pain Questionnaire. Pain and the brain: From nociception to cognition. Edited by: Bromm B, Desmedt J. 1995, Raven Press Ltd, New York

18.

Roland M, Morris R: A study of the natural history of back pain, part1: development of a reliable and sensitive measure of disability in low back pain. Spine. 1983, 8: 141-144. 10.1097/00007632-198303000-00004.PubMed

19.

Ware JE: SF36 Health survey update. Spine. 2000, 25: 3130-3139. 10.1097/00007632-200012150-00008.PubMed

20.

Kendall NAS, Linton SJ, Main CJ: Guide to assessing psychosocial yellow flags in acute low back pain: risk factors for long-term disability and work loss. 1997, Wellington: Accident Rehabilitation and Compensation Insurance Corporation of New Zealand and the national Health Committee, Ministry of Health, Wellington, New Zealand

21.

Hurley DA, Dusoir TE, McDonough SM, Moore AP, Linton SJ, Baxter GD: Biopsychosocial screening questionnaire for patients with low back pain: Preliminary report of utility in physiotherapy practice in Northern Ireland. The Clinical Journal of Pain. 2000, 16: 214-228. 10.1097/00002508-200009000-00007.PubMed

22.

Turk DC, Melzack R, (eds): Handbook of pain assessment. 1992, The Guildford Press. New York

23.

Katz J, Melzack R: Measurement of pain. Surgical clinics of North America. 1999, 79: 231-252. 10.1016/S0039-6109(05)70381-9.PubMed

24.

Gracey JH, McDonough SM, Baxter GD: Physiotherapy management of low back pain: a survey of current practice in Northern Ireland. Spine. 2002, 27: 406-411. 10.1097/00007632-200202150-00017.PubMed

25.

Maitland GD: Vertebral Manipulation. 2001, Edinburgh. Churchill and Livingstone, 8

26.

Cyriax J: Textbook of Orthopaedic Medicine. 1982, London: Bailliere Tindall, 1: 8

27.

Roland M, Waddell G, Klaber Moffett J, Burton K, Main C: The back book. 2002, Norwich. The stationary office, 2

28.

Stratford PW, Binkley JM, Riddle DL, Guyatt GH: Sensitivity to change of the Roland-Morris Back Pain questionnaire: Part 1. Physical therapy. 1998, 78: 1186-96.PubMed

29.

Sim J, Wright C: Research in Health care. Concepts, designs and methods. 2000, Cheltenham: Nelson Thornes Ltd, 351-

30.

Lidström A, Zachrisson M: Physical therapy on low back pain and sciatica. An attempt at evaluation. Scand J Rehabil Med. 1970, 2 (1): 37-42.PubMed

31.

Coxhead CE, Inskip H, Meade TW, North WR, Troup JD: Multicentre trial of physiotherapy in the management of sciatic symptoms. Lancet. 1981, 1 (8229): 1065-1068. 10.1016/S0140-6736(81)92238-8. 1981, May 16PubMed

32.

Pal P, Mangion P, Hossian MA, Diffey LA: Controlled trial of continuous lumbar traction in the treatment of back pain and sciatica. British Journal of Rheumatology. 1986, 25: 181-183. 10.1093/rheumatology/25.2.181.PubMed

33.

Sherry E, Kitchener P, Smart R: A prospective randomized controlled study of VAX-D and TENS for the treatment of chronic low back a pain. Neurological research. 2001, 23: 780-784. 10.1179/016164101101199180.PubMed

34.

Weber H: Traction therapy in sciatica due to disc prolapse (does traction treatment have any positive effect on patients suffering from sciatica caused by disc prolapse?). J Oslo City Hosp. 1973, 23 (10): 161-176.

35.

Matthews JA, Hicklings J: Lumbar traction: a double blind controlled study for sciatica. Rheumatology and rehabilitation. 1975, 14: 222-225. 10.1093/rheumatology/14.4.222.

36.

Weber H, Ljunggren AE, Walker L: Traction therapy in patients with herniated lumbar intervertebral discs. J Oslo City Hosp. 1984, 34 (7–8): 61-70.PubMed

37.

Ljunggren EA, Walker L, Weber H, Amundsen T: Manual traction versus isometric exercises in patients with herniated intervertebral lumbar discs. Physiotherapy Theory and Practice. 1992, 8: 207-213. 10.3109/09593989209108104.

38.

Larsson U, Choler U, Lidstrom A, Lind G, Nachemson A, Nilsson B, Roslund J: Autotraction for treatment of lumbago-sciatica. Acta Orthopaedica Scandinavica. 1980, 51: 791-798.PubMed

39.

Matthews JA, Mills SB, Jenkins VM, Grimes SM, Morkel MJ, Matthews W, Scott CM, Sittampalam Y: Back pain and sciatica: controlled trials of manipulation, traction, sclerosant and epidural injections. British journal of rheumatology. 1987, 26: 416-423. 10.1093/rheumatology/26.6.416.

40.

Harte AA, Baxter GD, Gracey JH: The efficacy of traction for back pain: A systematic review of randomized controlled trials. Arch Phys Med Rehabil. 2003, 84: 1542-1553. 10.1016/S0003-9993(03)00294-6.PubMed

41.

Bjordal JM, Greve G: What may alter the conclusion of reviews?. Physical Therapy Reviews. 1998, 3: 121-132.

42.

Herbert RD, Bo K: Analysis of quality of intervention in systematic reviews. BMJ. 2005, 331: 507-509. 10.1136/bmj.331.7515.507.PubMedPubMedCentral

43.

Jette AM, Delitto A: Physical therapy choices for musculoskeletal improvements. Physical therapy. 1997, 77: 145-154.PubMed

44.

Foster NE, Thompson KA, Baxter GD, Allen JM: Management of non-specific low back pain by physiotherapists in Britain and Ireland: a descriptive questionnaire of current clinical practice. Spine. 1999, 24: 1332-1342. 10.1097/00007632-199907010-00011.PubMed

45.

Li LC, Bombardier C: Physical therapy management of low back pain: An exploratory survey of therapist approaches. Physical therapy. 2001, 81: 1018-1027.PubMed

46.

Poitras S, Blais R, Swaine B, Rossignol M: Management of work-related low back pain: A population-based survey of physical therapists. Physical Therapy. 2005, 85: 1168-1181.PubMed

47.

Delitto A: Editorial. Research in low back pain: time to stop seeking the elusive 'magic bullet'. Physical therapy. 2005, 85: 206-208.PubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/8/118/prepub

Title: The effectiveness of motorised lumbar traction in the management of LBP with lumbo sacral nerve root involvement: a feasibility study
Authors: Annette A Harte
George D Baxter
Jacqueline H Gracey
Publication date: 01-12-2007
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2007
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/1471-2474-8-118

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effectiveness of motorised lumbar traction in the management of LBP with lumbo sacral nerve root involvement: a feasibility study

Abstract

Background

Methods

Results

Conclusion

Trial Registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial Registration

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