Identifying Patients With Chronic Low Back Pain Who Respond Best to Mechanical Diagnosis and Therapy: Secondary Analysis of a Randomized Controlled Trial.
BACKGROUND
"Mechanical Diagnosis and Therapy" (MDT) (also known as the McKenzie method), like other interventions for low back pain (LBP), has been found to have small effects for people with LBP. It is possible that a group of patients respond best to MDT and have larger effects. Identification of patients who respond best to MDT compared with other interventions would be an important finding.


OBJECTIVE
The purpose of the study was to investigate whether baseline characteristics of patients with chronic LBP, already classified as derangement syndrome, can identify those who respond better to MDT compared with Back School.


METHODS
This study was a secondary analysis of data from a previous trial comparing MDT with Back School in 148 patients with chronic LBP. Only patients classified at baseline assessment as being in the directional preference group (n=140) were included. The effect modifiers tested were: clear centralization versus directional preference only, baseline pain location, baseline pain intensity, and age. The primary outcome measures for this study were pain intensity and disability at the end of treatment (1 month). Treatment effect modification was evaluated by assessing the group versus predictor interaction terms from linear regression models. Interactions ≥1.0 for pain and ≥3 for disability were considered clinically important.


RESULTS
Being older met our criteria for being a potentially important effect modifier; however, the effect occurred in the opposite direction to our hypothesis. Older people had 1.27 points more benefit in pain reduction from MDT (compared with Back School) than younger participants after 1 month of treatment.


CONCLUSIONS
The sample (n=140) was powered to detect the main effects of treatment but not to detect the interactions of the potential treatment effect modifiers.


CONCLUSIONS
The results of the study suggest older age may be an important factor that can be considered as a treatment effect modifier for patients with chronic LBP receiving MDT. As the main trial was not powered for the investigation of subgroups, the results of this secondary analysis have to be interpreted cautiously, and replication is needed.
A.N. Garcia, PT, Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesario Galeno 475, São Paulo, Brazil, CEP 03071-000. alessandrag_narciso@yahoo.com.br.
Alessandra Narciso
AN
Garcia
L.C.M. Costa, PT, PhD, Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo.
Luciola da Cunha Menezes
Lda C
Costa
M. Hancock, PT, PhD, Discipline of Physiotherapy, Macquarie University, Sydney, New South Wales, Australia.
Mark
M
Hancock
L.O.P. Costa, PT, PhD, Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo.
Leonardo Oliveira Pena
LO
Costa
D000328:Adult; D000367:Age Factors; D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis / Q000628:therapy; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D018579:Patient Selection; D026741:Physical Therapy Modalities; D011237:Predictive Value of Tests