title: Predictors of functional outcome in patients with chronic low back pain undergoing back school, individual physiotherapy or spinal manipulation.
abstract: BACKGROUND
  Recent studies on chronic low back pain (cLBP) rehabilitation suggest that predictors of treatment outcome may be differ according to the considered conservative treatment.
  
  
  OBJECTIVE
  To identify predictors of response to back school (BS), individual physiotherapy (IP) or spinal manipulation (SM) for cLBP.
  
  
  METHODS
  outpatients with cLBP.
  
  
  METHODS
  Outpatient rehabilitation department.
  
  
  METHODS
  Retrospective analysis from a randomized trial.
  
  
  METHODS
  Two hundred and ten patients with cLBP were randomly assigned to either BS, IP or SM; the Roland Morris Disability Questionnaire (RM) was assessed before and after treatment: those who decreased their RM score <2.5 were considered non-responders. Baseline potential predictors of outcome included demographics, general and cLBP history, life satisfaction.
  
  
  RESULTS
  Of the 205 patients who completed treatment (140/205 women, age 58+14 years), non-responders were 72 (34.2%). SM showed the highest functional improvement and the lowest non-response rate. In a multivariable logistic regression, lower baseline RM score (OR 0.82, 95% CI 0.76-0.89, P<0.001) and received treatment (OR 0.32, 95% CI 0.21-0.50, P<0.001) were independent predictors of non-response. Being in the lowest tertile of baseline RM score (<6) predicted non response to treatment for BS and IP, but not for SM (same risk for all tertiles).
  
  
  CONCLUSIONS
  In our patients with cLBP lower baseline pain-related disability predicted non-response to physiotherapy, but not to spinal manipulation.
  
  
  CONCLUSIONS
  Our results suggest that, independent form other characteristics, patients with cLBP and low pain-related disability should first consider spinal manipulation as a conservative treatment.
authors.affiliation: Fondazione Don Carlo Gnocchi, Scientific Institute, Outpatient Rehabilitation Department, Florence, Italy. francescacecchi2002@libero.it
authors.forename: F
authors.initials: F
authors.lastname: Cecchi
authors.forename: S
authors.initials: S
authors.lastname: Negrini
authors.forename: G
authors.initials: G
authors.lastname: Pasquini
authors.forename: A
authors.initials: A
authors.lastname: Paperini
authors.forename: A A
authors.initials: AA
authors.lastname: Conti
authors.forename: M
authors.initials: M
authors.lastname: Chiti
authors.forename: F
authors.initials: F
authors.lastname: Zaina
authors.forename: C
authors.initials: C
authors.lastname: Macchi
authors.forename: R
authors.initials: R
authors.lastname: Molino-Lova
mesh_terms: D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000534:rehabilitation*; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D011379:Prognosis; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome