title: Derivation of a preliminary clinical prediction rule for identifying a subgroup of patients with low back pain likely to benefit from Pilates-based exercise.
abstract: METHODS
  Prospective cohort study.
  
  
  OBJECTIVE
  To derive a preliminary clinical prediction rule for identifying a subgroup of patients with low back pain (LBP) likely to benefit from Pilates-based exercise.
  
  
  BACKGROUND
  Pilates-based exercise has been shown to be effective for patients with LBP. However, no previous work has characterized patient attributes for those most likely to have a successful outcome from treatment.
  
  
  METHODS
  Ninety-six individuals with nonspecific LBP participated in the study. Treatment response was categorized based on changes in the Oswestry Disability Questionnaire scores after 8 weeks. An improvement of 50% or greater was categorized as achieving a successful outcome. Thirty-seven variables measured at baseline were analyzed with univariate and multivariate methods to derive a clinical prediction rule for successful outcome with Pilates exercise. Accuracy statistics, receiver-operator curves, and regression analyses were used to determine the association between standardized examination variables and treatment response status.
  
  
  RESULTS
  Ninety-five of 96 participants completed the study, with 51 (53.7%) achieving a successful outcome. A preliminary clinical prediction rule with 5 variables was identified: total trunk flexion range of motion of 70° or less, duration of current symptoms of 6 months or less, no leg symptoms in the last week, body mass index of 25 kg/m2 or greater, and left or right hip average rotation range of motion of 25° or greater. If 3 or more of the 5 attributes were present (positive likelihood ratio, 10.64), the probability of experiencing a successful outcome increased from 54% to 93%.
  
  
  CONCLUSIONS
  These data provide preliminary evidence to suggest that the response to Pilates-based exercise in patients with LBP can be predicted from variables collected from the clinical examination. If subsequently validated in a randomized clinical trial, this prediction rule may be useful to improve clinical decision making in determining which patients are most likely to benefit from Pilates-based exercise.
authors.affiliation: Graduate Program in Orthopedics, Rocky Mountain University of Health Professions, Provo, UT, USA. Lstolze@regis.edu
authors.forename: Lise R
authors.initials: LR
authors.lastname: Stolze
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Allison
authors.forename: John D
authors.initials: JD
authors.lastname: Childs
mesh_terms: D000328:Adult; D000368:Aged; D026241:Exercise Movement Techniques / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012372:ROC Curve; D016059:Range of Motion, Articular / Q000502:physiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome