Functional movement training for recurrent low back pain: lessons from a pilot randomized controlled trial.
OBJECTIVE
Despite considerable effort to reduce low back pain (LBP), approximately 60% of patients have recurrence after their first episode. The high rate of recurrence suggests that more effective intervention approaches are needed. This randomized, controlled feasibility trial was designed to compare disability, physical functional capacity, and pain outcomes at 2, 6, and 12 months for 2 conventional and 1 novel physical therapy (functional movement training) intervention for recurrent LBP.


METHODS
Randomized, controlled feasibility trial.


METHODS
University hospital outpatient physical therapy clinic.


METHODS
Sixty-one participants (60% female) with recurrent LBP.


METHODS
Subjects were randomized to 1 of 3 intervention groups: group 1 had a single session consisting of standard back pain education; group 2 had 6 sessions in 8 weeks of conventional physical therapy; and group 3 had 6 sessions in 8 weeks of a novel method of functional movement training. Change from baseline was used to determine within-group changes and between-group differences for participants who finished each time point (2, 6, and 12 months). Changes were evaluated using analysis of variance and Newman-Keuls post hoc analysis.


METHODS
The primary outcome measure was the novel Continuous Scale Physical Functional Performance test (CS-PFP), a measure of actual physical functional capacity. Secondary measures included the revised Oswestry Disability Index, a measure of pain-related disability, the Roland Morris Disability Questionnaire, and a standard visual analogue pain scale.


RESULTS
Of the participants, 67% provided data at 2 months and 44% provided information at 12 months. Raw change scores were evaluated at 2, 6, and 12 months. While no statistical significance was reached with any outcome measure, the trends suggested little change for group 1 (education) and suggested that greatest improvement in function may occur in group 3 (functional movement training). In particular, at 2 months, the CS-PFP change scores revealed a trend (P=.072) toward greater improvement in groups 2 (conventional physical therapy) and 3 (functional movement training) compared with group 1. At 12 months, Oswestry Disability Index and CS-PFP scores also trended toward significance for groups 2 and 3 (P=.7 and .9, respectively). Mean change scores were also calculated and revealed groups 2 and 3 had improved by 2 months and this improvement remained stable at the 1-year mark. Trends in the direction of best improvement occurred for those in the functional movement training group.


CONCLUSIONS
A large-scale randomized, controlled trial is warranted to determine whether an intervention based on functional movement training is superior to conventional, impairment-based intervention for individuals with recurrent LBP.
Schenkman
Margaret L
ML
Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Aurora, CO, USA.
Jordan
Sharon
S
Akuthota
Venu
V
Roman
Matthew
M
Kohrt
Wendy M
WM
Hearty
Thomas
T
Cleary
Catherine
C
Backstrom
Karen Maloney
KM
D000203:Activities of Daily Living; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008019:Life Style; D017116:Low Back Pain / Q000517:prevention & control* / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D055502:Secondary Prevention; D016896:Treatment Outcome