Purpose: Clinical practice guideline (CPG) concordant treatment (Ctx) has been shown to be more effective than CPG discordant care (Dtx) in a heterogeneous cohort of patients with acute lower back pain (ALBP). However, patients with underlying spine pathology (e.g. stenosis, disc degeneration, facet joint arthropathy) or without identifiable spine pathology may all present solely with ALBP. At present, it is unknown if underlying spine pathology influences the outcome of Ctx. The purpose of this study was to determine if Ctx is more effective than Dtx in patients with differing underlying spine pathology who present with ALBP.

Method: A Two-arm, randomized control trial with stratified analysis. Inclusion: Ages 19–59; QTFSD I, II ALBP < 4 weeks. Exclusion: “Red Flag” conditions, comorbidities contraindicating Ctx. The primary outcome was the difference between Ctx and Dtx Roland Morris Disability (RDQ) scores at 16 weeks post baseline between study groups. Secondary outcomes: differences in Bodily Pain (BP), Physical Functioning (PF) SF-36 domain scores at 16 weeks. Patients were assessed by a spine physician and randomized to Ctx or Dtx. Patients were stratified on the basis of CT or MRI evidence of:

spinal stenosis;

Hospital / University Ethics approval was obtained.

Results: Eighty-eight patients were recruited; 39 in Ctx & 38 in Dtx group completed the study. Baseline prognostic variables were evenly distributed between groups. Outcomes: mean difference in 16 week RDQ, BP and PF scores between Ctx and Dtx was statistically greatest in group 4 (p< 0.001). There was no significant clinical improvement in RDQ, BP or PF scores in either the Ctx or Dtx in group 2.

Conclusion: Ctx was more effective than Dtx in patients with no identifiable spine pathology and ineffective and equivalent to Dtx in patients with underlying disc degeneration.