title: Efficacy of directional preference management for low back pain: a systematic review.
abstract: 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.
authors.affiliation: Musculoskeletal Research Centre, Department of Physiotherapy, Faculty of Health Sciences, Level 2, HS3, La Trobe University, Bundoora, Victoria 3086, Australia. lsurkitt@optusnet.com.au
authors.forename: Luke D
authors.initials: LD
authors.lastname: Surkitt
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Ford
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Hahne
authors.forename: Tania
authors.initials: T
authors.lastname: Pizzari
authors.forename: Joan M
authors.initials: JM
authors.lastname: McMeeken
mesh_terms: D004185:Disability Evaluation; D006801:Humans; D017116:Low Back Pain / Q000145:classification / Q000628:therapy*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic; D012107:Research Design