Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial.
BACKGROUND
It is unknown if low back pain (LBP) outcomes are enhanced by classification-specific treatment based on the Movement System Impairment classification system. The moderating effect of adherence to treatment also is unknown.


OBJECTIVE
Compare the efficacy of a classification-specific treatment (CS) and a non classification-specific (NCs) treatment and examine the moderating effect of adherence on outcomes.


METHODS
2 center, 2 parallel group, prospective, randomized, clinical trial.


METHODS
Participants with chronic LBP were classified and randomized. Self-report data was obtained at baseline, post-treatment, and 6 and 12 months post-treatment. The primary outcome was the modified Oswestry Disability Index (mODI; 0-100%). Treatment effect modifiers were exercise adherence and performance training adherence. An intention to treat approach and hierarchical linear modeling were used.


RESULTS
47 people received CS treatment, 54 people received NCs treatment. Treatment groups did not differ in mODI scores (p > 0.05). For both groups, scores improved with treatment (p < 0.05), plateaued at 6 months (p > 0.05), and minimally regressed at 12 months (p < 0.05). Performance training adherence had a unique, independent effect on mODI scores above and beyond the effect of exercise adherence (p < 0.05). There were no treatment group effects on the relationship between mODI scores and the two types of adherence (p < 0.05).


CONCLUSIONS
There were no differences in function between the two treatment groups (CS and NCs). In both treatment groups, people with chronic LBP displayed clinically important long-term improvements in function. When both forms of adherence were considered, the improvements were uniquely related to adherence to performance training.
Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO, 63110, USA. Electronic address: vandillenl@wusm.wustl.edu.
Linda R
LR
Van Dillen
Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Neurology, Washington University School of Medicine, Campus Box 8111, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
Barbara J
BJ
Norton
Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Neurology, Washington University School of Medicine, Campus Box 8111, 660 S. Euclid Ave, St. Louis, MO, 63110, USA; Department of Cell Biology and Physiology, Washington University School of Medicine, Campus Box 8228, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
Shirley A
SA
Sahrmann
Department of Medicine, Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S Euclid Ave, St. Louis, MO, 63110, USA.
Bradley A
BA
Evanoff
Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
Marcie
M
Harris-Hayes
Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 S. Euclid Ave, St. Louis, MO, 63110, USA.
Gregory W
GW
Holtzman
Physical Therapy Department, The Rehabilitation Institute of Saint Louis, 4455 Duncan Avenue, St. Louis, MO, 63110, USA.
Jeanne
J
Earley
Physical Therapy Department, The Rehabilitation Institute of Saint Louis, 4455 Duncan Avenue, St. Louis, MO, 63110, USA.
Irene
I
Chou
Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Boulevard, St. Louis, MO, 63108, USA; Department of Psychology, Washington University, Campus Box 1125, One Brookings Drive, St. Louis, MO, 63130, USA.
Michael J
MJ
Strube
D000293:Adolescent; D000328:Adult; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000145:classification* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D057566:Self Report; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
Adherence; Classification; Low back pain