title: Can a within/between-session change in pain during reassessment predict outcome using a manual therapy intervention in patients with mechanical low back pain?
abstract: The purposes of the study were to determine whether the combined occurrence of within/between-session changes were significantly associated with functional outcomes, pain, and self-report of recovery in patients at discharge who were treated with manual therapy for low back pain. A secondary purpose was to determine the extent of change needed for the within/between-session change with association to function. The study involved 100 subjects who were part of a randomized controlled trial that examined manual therapy techniques who demonstrated a positive response to manual therapy during the initial assessment. Within- and between-session findings (within/between session) were defined as a change in pain report from baseline to after the second physiotherapy visit. Within/between-session changes were analyzed for associations between pain change scores at discharge, rate of recovery, and a 50% reduction of the Oswestry disability index (ODI) by discharge. The results suggest there is a significant association between a within/between-session change after the second physiotherapy visit and discharge outcomes for pain and ODI in this sample of patients who received a manual therapy intervention. A 2-point change or greater on an 11-point scale is associated with functional recovery at discharge and accurately described the outcome in 67% of the cases. This is the first study that has shown an association of within/between-session changes with disability scores at discharge and is the first to define the extent of change necessary for prognosis of an outcome. A within/between-session change should be considered as a complimentary artifact along with other examination findings during clinical decision making.
authors.affiliation: Division of Physical Therapy, Walsh University, North Canton, OH 44720, USA. ccook@walsh.edu
authors.forename: Chad E
authors.initials: CE
authors.lastname: Cook
authors.forename: Chris
authors.initials: C
authors.lastname: Showalter
authors.forename: Vincent
authors.initials: V
authors.lastname: Kabbaz
authors.forename: Bryan
authors.initials: B
authors.lastname: O'Halloran
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000503:physiopathology* / Q000534:rehabilitation*; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult