title: Predicting response to motor control exercises and graded activity for patients with low back pain: preplanned secondary analysis of a randomized controlled trial.
abstract: BACKGROUND
  Current treatments for low back pain have small effects. A research priority is to identify patient characteristics associated with larger effects for specific interventions.
  
  
  OBJECTIVE
  The aim of this study was to identify simple clinical characteristics of patients with chronic low back pain who would benefit more from either motor control exercises or graded activity.
  
  
  METHODS
  This study was a secondary analysis of the results of a randomized controlled trial.
  
  
  METHODS
  One hundred seventy-two patients with chronic low back pain were enrolled in the trial, which was conducted in Australian physical therapy clinics. The treatment consisted of 12 initial exercise sessions over an 8-week period and booster sessions at 4 and 10 months following randomization. The putative effect modifiers (psychosocial features, physical activity level, walking tolerance, and self-reported signs of clinical instability) were measured at baseline. Measures of pain and function (both measured on a 0-10 scale) were taken at baseline and at 2, 6, and 12 months by a blinded assessor.
  
  
  RESULTS
  Self-reported clinical instability was a statistically significant and clinically important modifier of treatment response for 12-month function (interaction: 2.72; 95% confidence interval=1.39 to 4.06). Participants with high scores on the clinical instability questionnaire (≥9) did 0.76 points better with motor control exercises, whereas those who had low scores (<9) did 1.93 points better with graded activity. Most other effect modifiers investigated did not appear to be useful in identifying preferential response to exercise type.
  
  
  CONCLUSIONS
  The psychometric properties of the instability questionnaire have not been fully tested.
  
  
  CONCLUSIONS
  A simple 15-item questionnaire of features considered indicative of clinical instability can identify patients who respond best to either motor control exercises or graded activity.
authors.affiliation: L.G. Macedo, PT, PhD, Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, Alberta T6G 2G4, Canada. lmacedo@ualberta.ca lucianagazzi@hotmail.com.
authors.forename: Luciana Gazzi
authors.initials: LG
authors.lastname: Macedo
authors.affiliation: C.G. Maher, PT, PhD, The George Institute for Global Health, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Maher
authors.affiliation: M.J. Hancock, PT, PhD, Discipline of Physiotherapy, Faculty of Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Hancock
authors.affiliation: S.J. Kamper, PT, PhD, EMGO+ Institute, VU University Medical Centre, Amsterdam, the Netherlands, and The George Institute for Global Health, The University of Sydney.
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Kamper
authors.affiliation: J.H. McAuley, PhD, Neuroscience Research Australia, Sydney, New South Wales, Australia.
authors.forename: James H
authors.initials: JH
authors.lastname: McAuley
authors.affiliation: T.R. Stanton, PT, PhD, School of Health Sciences, The University of South Australia, Adelaide, South Australia, Australia, and Neuroscience Research Australia.
authors.forename: Tasha R
authors.initials: TR
authors.lastname: Stanton
authors.affiliation: R. Stafford, PhD, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Ryan
authors.initials: R
authors.lastname: Stafford
authors.affiliation: P.W. Hodges, PT, PhD, Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Hodges
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D059350:Chronic Pain / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D004644:Emotions; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012307:Risk Factors; D020377:Self Efficacy; D057566:Self Report; D016896:Treatment Outcome