Does early change predict long-term (6 months) improvements in subjects who receive manual therapy for low back pain?

Abstract

Early change is commonly assessed for manual therapy interventions and has been used to determine treatment appropriateness. However, current studies have only explored the relationship of between or within-session changes and short-/medium-term outcomes. The goal of this study was to determine whether pain changes after two weeks of pragmatic manual therapy could predict those participants with chronic low back pain who demonstrate continued improvements at 6-month follow-up. This study was a retrospective observational design. Univariate logistic regression analyses were performed using a 33% and a 50% pain change to predict improvement. Those who experienced a ≥33% pain reduction by 2 weeks had 6.98 (95% CI = 1.29, 37.53) times higher odds of 50% improvement on the GRoC and 4.74 (95% CI = 1.31, 17.17) times higher odds of 50% improvement on the ODI (at 6 months). Subjects who reported a ≥50% pain reduction at 2 weeks had 5.98 (95% CI = 1.56, 22.88) times higher odds of a 50% improvement in the GRoC and 3.99 (95% CI = 1.23, 12.88) times higher odds of a 50% improvement in the ODI (at 6 months). Future studies may investigate whether a change in plan of care is beneficial for patients who are not showing early improvement predictive of a good long-term outcome.

The role of pain and disability changes after physiotherapy treatment on global perception of improvement in patients with chronic low back pain

“…However, the odd ratios values representing this relationship were substantially lower in patients with CLBP (Kamper et al, 2010a). Secondly, recent studies have demonstrated early pain changes in the intervention and its predictive value for success in others variables after the intervention (Cook et al, 2017;Mansell et al, 2017). Therefore, pain changes may act as facilitators for the disability changes that are more easily perceived as important by the patients after the intervention.…”

Kronik Bel Ağrılı Kadın Hastalarda Ev Egzersiz Programı ile Manuel Terapinin Etkinlik Düzeylerinin Karşılaştırılması

“…They reassessed the patients they treated after 6 months to assess the medium-term efficacy. They reported that the long-term recovery rate was higher in the group of patients who showed greater improvement after two weeks of manual therapy (9). In this study, unlike our study, the long-term curative effect of manual therapy was investigated and it was emphasized that the post-treatment effect was longer in low back pain patients.…”

Symptom versus condition modifying care: Can such a dichotomy be useful?

“…Of course, one might think of many instances where focus on the modification of symptoms in the short-term, allows for person engagement in those behaviours and activities that may improve medium to long term outcomes. This notion is supported by some retrospective observational data [17] where, for example, the short-term improvement in global rating of change scores and function, as a result of manual therapy treatment in people with low back pain, has been shown to be associated with up to a 6 or 4 times, retrospectively, improvement in these measures at the 6 month time point. However, level 1 research suggests that there is no conclusive evidence that early changes in either pain intensity or pain location offer good longer-term prognosis on a variety of outcomes for people with musculoskeletal conditions [18].…”