DOES TARGETING MANUAL THERAPY AND/OR EXERCISE IMPROVE PATIENT OUTCOMES IN NONSPECIFIC LOW BACK PAIN? – A SYSTEMATIC REVIEW

Purpose of study and background

This systematic review sought to determine the efficacy of such targeted treatment in adults with non-specific low back pain (NSLBP).

Many clinicians and researchers believe that tailoring treatment to subgroups of NSLBP positively impacts on patient outcomes.

Method and results

MEDLINE, EMBASE, Current Contents, AMED, the Cochrane Central Register of Controlled Trials, reference list searching and citation tracking. Inclusion criteria were randomised controlled trials of targeted manual therapy and/or exercise for NSLPB that used trial designs capable of providing robust information on targeted treatment (treatment effect modification) for the outcomes of activity limitation and pain. Included trials needed to be hypothesis-testing studies published in English, Danish or Norwegian. Method quality was assessed using the Cochrane Back Review Group criteria.

Four high-quality trials of targeted manual therapy and/or exercise for NSLBP met the inclusion criteria. One study showed statistically significant effects for short-term outcomes using McKenzie directional preference-based exercise. Other included studies showed effects that might be clinically important in size but were not statistically significant with their samples sizes, as research into subgroups requires much larger sample sizes than traditional two-group trials.

Conclusions

The clinical implications of these results are that they provide very cautious evidence supporting the notion that treatment targeted to subgroups of patients with NSLBP may improve patient outcomes. The results were too patchy, inconsistent, and investigated in samples too small for clinical recommendations to be based on these findings. The research implications are that adequately powered controlled trials of treatment effect modification are uncommon.