Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2015

Open Access 01-12-2015 | Research article

Predicting a clinically important outcome in patients with low back pain following McKenzie therapy or spinal manipulation: a stratified analysis in a randomized controlled trial

Authors: Tom Petersen, Robin Christensen, Carsten Juhl

Published in: BMC Musculoskeletal Disorders | Issue 1/2015

Login to get access

Abstract

Background

Reports vary considerably concerning characteristics of patients who will respond to mobilizing exercises or manipulation. The objective of this prospective cohort study was to identify characteristics of patients with a changeable lumbar condition, i.e. presenting with centralization or peripheralization, that were likely to benefit the most from either the McKenzie method or spinal manipulation.

Methods

350 patients with chronic low back pain were randomized to either the McKenzie method or manipulation. The possible effect modifiers were age, severity of leg pain, pain-distribution, nerve root involvement, duration of symptoms, and centralization of symptoms. The primary outcome was the number of patients reporting success at two months follow-up. The values of the dichotomized predictors were tested according to the prespecified analysis plan.

Results

No predictors were found to produce a statistically significant interaction effect. The McKenzie method was superior to manipulation across all subgroups, thus the probability of success was consistently in favor of this treatment independent of predictor observed. When the two strongest predictors, nerve root involvement and peripheralization, were combined, the chance of success was relative risk 10.5 (95% CI 0.71-155.43) for the McKenzie method and 1.23 (95% CI 1.03-1.46) for manipulation (P = 0.11 for interaction effect).

Conclusions

We did not find any baseline variables which were statistically significant effect modifiers in predicting different response to either McKenzie treatment or spinal manipulation when compared to each other. However, we did identify nerve root involvement and peripheralization to produce differences in response to McKenzie treatment compared to manipulation that appear to be clinically important. These findings need testing in larger studies.

Trial registration

Clinicaltrials.gov: NCT00939107
Appendix
Available only for authorised users
Literature
1.
Chou R, Qaseem A, Snow V, Casey D, Cross Jr JT, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478–91.CrossRefPubMed
2.
NHS. Early management of persistent non-specific low back pain. NICE Clinical Guideline. 2009;88:1–30.
3.
Cherkin DC, Battie MC, Deyo RA, Street JH, Barlow W. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med. 1998;339(15):1021–9.CrossRefPubMed
4.
Paatelma M, Kilpikoski S, Simonen R, Heinonen A, Alen M, Videman T. Orthopaedic manual therapy, McKenzie method or advice only for low back pain in working adults. A randomized controlled trial with 1 year follow-up. J Rehabil Med. 2008;40(10):858–63.CrossRefPubMed
5.
Foster NE, Dziedzic KS, van Der Windt DA, Fritz JM, Hay EM. Research priorities for non-pharmacological therapies for common musculoskeletal problems: nationally and internationally agreed recommendations. BMC Musculoskelet Disord. 2009;10:3.CrossRefPubMedPubMedCentral
6.
Kamper SJ, Maher CG, Hancock MJ, Koes BW, Croft PR, Hay E. Treatment-based subgroups of low back pain: a guide to appraisal of research studies and a summary of current evidence. Best Pract Res Clin Rheumatol. 2010;24(2):181–91.CrossRefPubMed
7.
Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15 Suppl 2:S192–300.CrossRefPubMedPubMedCentral
8.
Hingorani AD, Windt DA, Riley RD, Abrams K, Moons KG, Steyerberg EW, et al. Prognosis research strategy (PROGRESS) 4: Stratified medicine research. BMJ. 2013;346:e5793.CrossRefPubMedPubMedCentral
9.
Fersum KV, Dankaerts W, O’Sullivan PB, Maes J, Skouen JS, Bjordal JM, et al. Integration of sub-classification strategies in RCTs evaluating manual therapy treatment and exercise therapy for non-specific chronic low back pain (NSCLBP): a systematic review. Br J Sports Med. 2010;44(14):1054–62.CrossRefPubMed
10.
Erhard RE, Delitto A, Cibulka MT. Relative effectiveness of an extension program and a combined program of manipulation and flexion and extension exercises in patients with acute low back syndrome. Phys Ther. 1994;74(12):1093–100.PubMed
11.
Schenk RJ, Josefczyk C, Kopf A. A randomized trial comparing interventions in patients with lumbar posterior derangement. J Man Manipul Ther. 2003;11(2):95–102.CrossRef
12.
Kilpikoski S, Alen M, Paatelma M, Simonen R, Heinonen A, Videman T. Outcome comparison among working adults with centralizing low back pain: Secondary analysis of a randomized controlled trial with 1-year follow-up. Adv Physiol Educ. 2009;11:210–7.
13.
Petersen T, Larsen K, Nordsteen J, Olsen S, Fournier G, Jacobsen S. The McKenzie method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization. A randomized controlled trial. Spine (Phila Pa 1976). 2011;36(24):1999–2010.CrossRef
14.
Petersen T, Olsen S, Laslett M, Thorsen H, Manniche C, Ekdahl C, et al. Inter-tester reliability of a new diagnostic classification system for patients with non-specific low back pain. Aust J Physiother. 2004;50:85–94.CrossRefPubMed
15.
Waddell G, McCulloch JA, Kummel E, Venner RM. Nonorganic physical signs in low-back pain. Spine. 1980;5(2):117–25.CrossRefPubMed
16.
Manniche C, Asmussen K, Lauritsen B, Vinterberg H, Kreiner S, Jordan A. Low Back Pain Rating scale: validation of a tool for assessment of low back pain. Pain. 1994;57(3):317–26.CrossRefPubMed
17.
McKenzie RA. Treat your own back. Waikanae: Spinal Publications New Zealand Ltd; 1997.
18.
Burton AK, Waddell G, Tillotson KM, Summerton N. Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care. Spine. 1999;24(23):2484–91.CrossRefPubMed
19.
Patrick DL, Deyo RA, Atlas SJ, Singer DE, Chapin A, Keller RB. Assessing health-related quality of life in patients with sciatica. Spine. 1995;20(17):1899–908.CrossRefPubMed
20.
Albert H, Jensen AM, Dahl D, Rasmussen MN. Criteria validation of the Roland Morris questionnaire. A Danish translation of the international scale for the assessment of functional level in patients with low back pain and sciatica [Kriterievalidering af Roland Morris Spørgeskemaet - Et oversat internationalt skema til vurdering af ændringer i funktionsniveau hos patienter med lændesmerter og ischias]. Ugeskr Laeger. 2003;165(18):1875–80.PubMed
21.
Bombardier C, Hayden J, Beaton DE. Minimal clinically important difference. Low back pain: outcome measures. J Rheumatol. 2001;28(2):431–8.PubMed
22.
Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von KM, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine. 2008;33(1):90–4.CrossRefPubMed
23.
Moons KG, Royston P, Vergouwe Y, Grobbee DE, Altman DG. Prognosis and prognostic research: what, why, and how? BMJ. 2009;338:1317–20.CrossRef
24.
Sun X, Briel M, Walter SD, Guyatt GH. Is a subgroup effect believable? Updating criteria to evaluate the credibility of subgroup analyses. BMJ. 2010;340:c117.CrossRefPubMed
25.
Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine. 2004;29(23):2593–602.CrossRefPubMed
26.
Long A, May S, Fung T. The comparative prognostic value of directional preference and centralization: a useful tool for front-line clinicians? J Man Manip Ther. 2008;16(4):248–54.CrossRefPubMedPubMedCentral
27.
Koes BW, Bouter LM, van Mameren H, Essers AH, Verstegen GJ, Hofhuizen DM, et al. A randomized clinical trial of manual therapy and physiotherapy for persistent back and neck complaints: subgroup analysis and relationship between outcome measures. J Manipulative Physiol Ther. 1993;16(4):211–9.PubMed
28.
Leboeuf-Yde C, Gronstvedt A, Borge JA, Lothe J, Magnesen E, Nilsson O, et al. The nordic back pain subpopulation program: demographic and clinical predictors for outcome in patients receiving chiropractic treatment for persistent low”back pain. J Manipulative Physiol Ther. 2004;27(8):493–502.CrossRefPubMed
29.
Nyiendo J, Haas M, Goldberg B, Sexton G. Pain, disability, and satisfaction outcomes and predictors of outcomes: a practice-based study of chronic low back pain patients attending primary care and chiropractic physicians. J Manipulative Physiol Ther. 2001;24(7):433–9.CrossRefPubMed
30.
Foster NE, Hill JC, Hay EM. Subgrouping patients with low back pain in primary care: are we getting any better at it? Man Ther. 2011;16(1):3–8.CrossRefPubMed
31.
Underwood MR, Morton V, Farrin A. Do baseline characteristics predict response to treatment for low back pain? Secondary analysis of the UK BEAM dataset. Rheumatology (Oxford). 2007;46(8):1297–302.CrossRef
32.
Slater SL, Ford JJ, Richards MC, Taylor NF, Surkitt LD, Hahne AJ. The effectiveness of sub-group specific manual therapy for low back pain: a systematic review. Man Ther. 2012;17(3):201–12.CrossRefPubMed
33.
Stanton TR, Hancock MJ, Maher CG, Koes BW. Critical appraisal of clinical prediction rules that aim to optimize treatment selection for musculoskeletal conditions. Phys Ther. 2010;90(6):843–54.CrossRefPubMed
Metadata
Title
Predicting a clinically important outcome in patients with low back pain following McKenzie therapy or spinal manipulation: a stratified analysis in a randomized controlled trial
Authors
Tom Petersen
Robin Christensen
Carsten Juhl
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2015
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-015-0526-1

Other articles of this Issue 1/2015

BMC Musculoskeletal Disorders 1/2015 Go to the issue

Research article

Validity of flounce sign to rule out medial meniscus tear in knee arthroscopy

Research article

A screening tool for non-specific low back pain with disability in office workers: a 1-year prospective cohort study

Research article

Validation of the German version of the STarT-Back Tool (STarT-G): a cohort study with patients from primary care practices

Research article

Clinical characteristics and biopsy accuracy in suspected cases of Sjögren’s syndrome referred to labial salivary gland biopsy

Research article

Frequency of sarcopenia and associated factors among hospitalized elderly patients

Research article

A randomised trial into the effect of an isolated hip abductor strengthening programme and a functional motor control programme on knee kinematics and hip muscle strength