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Efficacy of directional preference management for low back pain: a systematic review
Luke D Surkitt1, Jon J Ford, Andrew J Hahne
1Musculoskeletal Research Centre, Department of Physiotherapy, Faculty of Health Sciences, Level 2, HS3, La Trobe University, Bundoora, Victoria 3086, Australia. lsurkitt@optusnet.com.au
Background:
Providing specific treatment based on symptom response for people with low back pain (LBP) and a directional preference (DP) is a widely used treatment approach. The efficacy of treatment using the principles of directional preference management (DPM) for LBP is unclear.
Objective:
The purpose of this study was to determine the efficacy of treatment using the principles of DPM for people with LBP and a DP.
Methods:
Computer databases were searched for randomized controlled trials (RCTs) published in English up to January 2010. Only RCTs investigating DPM for people with LBP and a DP were included. Outcomes for pain, back specific function, and work participation were extracted.
Results:
Six RCTs were included in this review. Five were considered high quality. Clinical heterogeneity of the included trials prevented meta-analysis. GRADE quality assessment revealed mixed results; however, moderate evidence was identified that DPM was significantly more effective than a number of comparison treatments for pain, function, and work participation at short-term, intermediate-term, and long-term follow-ups. No trials found that DPM was significantly less effective than comparison treatments.
Conclusions:
Although this systematic review showed mixed results, some evidence was found supporting the effectiveness of DPM when applied to participants with a DP, particularly at short-term and intermediate-term follow-ups. Further high-quality RCTs are warranted to evaluate the effect of DPM applied to people with LBP and a DP.
