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Classification-guided versus generalized postural intervention in subgroups of nonspecific chronic low back pain: a
Liba Sheeran1, Robert van Deursen, Bruce Caterson
1*Research Centre for Clinical Kinaesiology, School of Healthcare Studies, Cardiff University, Cardiff, Wales, United Kingdom †School of Biosciences, Cardiff University, Cardiff, Wales, United Kingdom; and ‡Research Centre for Clinical Kinaesiology School of Healthcare Studies, Cardiff Institute of Tissue Engineering and Repair, Cardiff University, Cardiff, Wales, United Kingdom.
Study Design:
Pragmatic randomized controlled single-blinded study.
Objective:
To compare the effects of the classification system guided postural intervention (CSPI) with generalized postural intervention (GPI) in subgroups of nonspecific 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 specific movement/posture impairments in NSCLBP subgroups is therefore warranted.
Methods:
A total of 49 patients with NSCLBP with a classification 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 significant 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 significant improvements in disability and pain outcomes and short-term improvements in some parameters of spinal repositioning sense in NSCLBP subgroups.
