Outcomes differ between subgroups of patients with low back and leg pain following neural manual therapy: a prospective cohort study.
The objective is to determine if pain and disability outcomes of patients treated with neural mobilisation differ for sub-classifications of low back and leg pain (LB&LP). Radiating leg pain is a poor prognostic factor for recovery in patients with LBP. To improve outcome, a new pathomechanism-based classification system was proposed: neuropathic sensitization (NS), denervation (D), peripheral nerve sensitization (PNS) and musculoskeletal (M). Seventy-seven patients with unilateral LB&LP were recruited. Following classification, all subjects were treated seven times with neural mobilisation techniques. A successful outcome was defined as achieving a minimal clinically important change in pain intensity (11-point numerical rating scale), physical function (Roland Morris disability questionnaire) and global perceived change (7-point Likert scale: from 1 = "completely recovered" to 7 = "worse than ever"). The proportion of responders was significantly greater in PNS (55.6%) than the other three groups (NS 10%; D 14.3% and M10%). After adjusting for baseline differences, mean magnitude of improvement of the outcome measures were significantly greater in PNS compared to the other groups. Patients classified as PNS have a more favourable prognosis following neural mobilisation compared to the other groups.
Faculty of Social Work and Health, Degree Programmes for Occupational Therapy, Speech and Language Therapy & Physiotherapy, HAWK University of Applied Science and Arts, Goschentor 1, 31134 Hildesheim, Germany. meender@web.de
Axel
A
Schäfer
Toby
T
Hall
Gerd
G
Müller
Kathryn
K
Briffa
D000328:Adult; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000145:classification / Q000628:therapy*; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011446:Prospective Studies; D012585:Sciatica / Q000145:classification / Q000628:therapy*; D016896:Treatment Outcome