title: Sub-classification based specific movement control exercises are superior to general exercise in sub-acute low back pain when both are combined with manual therapy: A randomized controlled trial.
abstract: BACKGROUND
  Clinical guidelines recommend research on sub-groups of patients with low back pain (LBP) but, to date, only few studies have been published. One sub-group of LBP is movement control impairment (MCI) and clinical tests to identify this sub-group have been developed. Also, exercises appear to be beneficial for the management of chronic LBP (CLBP), but very little is known about the management of sub-acute LBP.
  
  
  METHODS
  A randomized controlled trial (RCT) was conducted to compare the effects of general exercise versus specific movement control exercise (SMCE) on disability and function in patients with MCI within the recurrent sub-acute LBP group. Participants having a MCI attended five treatment sessions of either specific or general exercises. In both groups a short application of manual therapy was applied. The primary outcome was disability, assessed by the Roland-Morris Disability Questionnaire (RMDQ). The measurements were taken at baseline, immediately after the three months intervention and at twelve-month follow-up.
  
  
  RESULTS
  Seventy patients met the inclusion criteria and were eligible for the trial. Measurements of 61 patients (SMCE n = 30 and general exercise n = 31) were completed at twelve months. (Drop-out rate 12.9 %). Patients in both groups reported significantly less disability (RMDQ) at twelve months follow-up. However, the mean change on the RMDQ between baseline and the twelve-month measurement showed statistically significantly superior improvement for the SMCE group -1.9 points (-3.9 to -0.5) 95 % (CI). The result did not reach the clinically significant three point difference. There was no statistical difference between the groups measured with Oswestry Disability Index (ODI).
  
  
  CONCLUSIONS
  For subjects with non-specific recurrent sub-acute LBP and MCI an intervention consisting of SMCE and manual therapy combined may be superior to general exercise combined with manual therapy.
  
  
  BACKGROUND
  The study protocol registration number is ISRCTN48684087 . It was registered retrospectively 18th Jan 2012.
authors.affiliation: Department of Physical and Rehabilitation Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland. vesa.lehtola@omt.org.|, Allintie 8, 48100, Kotka, Finland. vesa.lehtola@omt.org.
authors.forename: Vesa
authors.initials: V
authors.lastname: Lehtola
authors.affiliation: Zürich University of Applied Sciences ZHAW, Institut for Physiotherapy, Winterthur, Switzerland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Luomajoki
authors.affiliation: Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.|Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
authors.forename: Ville
authors.initials: V
authors.lastname: Leinonen
authors.affiliation: Faculty of Medicine, Department of Clinical Epidemiology, Memorial University of Newfoundland, Newfoundland, Canada.
authors.forename: Sean
authors.initials: S
authors.lastname: Gibbons
authors.affiliation: Department of Physical and Rehabilitation Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.|Kuopio University Hospital, Kuopio, Finland.
authors.forename: Olavi
authors.initials: O
authors.lastname: Airaksinen
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D026241:Exercise Movement Techniques; D005260:Female; D005387:Finland; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D010147:Pain Measurement; D020127:Recovery of Function; D012008:Recurrence; D013131:Spine / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome