The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial

Abstract

BackgroundLow back pain is a highly prevalent and disabling condition worldwide. Clinical guidelines for the management of patients with acute low back pain recommend first-line treatment consisting of advice, reassurance and simple analgesics. Exercise is also commonly prescribed to these patients. The primary aim of this study was to evaluate the short-term effect of adding the McKenzie method to the first-line care of patients with acute low back pain.MethodsA multi-centre randomized controlled trial with a 3-month follow-up was conducted between September 2005 and June 2008. Patients seeking care for acute non-specific low back pain from primary care medical practices were screened. Eligible participants were assigned to receive a treatment programme based on the McKenzie method and first-line care (advice, reassurance and time-contingent acetaminophen) or first-line care alone, for 3 weeks. Primary outcome measures included pain (0-10 Numeric Rating Scale) over the first seven days, pain at 1 week, pain at 3 weeks and global perceived effect (-5 to 5 scale) at 3 weeks. Treatment effects were estimated using linear mixed models.ResultsOne hundred and forty-eight participants were randomized into study groups, of whom 138 (93%) completed the last follow-up. The addition of the McKenzie method to first-line care produced statistically significant but small reductions in pain when compared to first-line care alone: mean of -0.4 points (95% confidence interval, -0.8 to -0.1) at 1 week, -0.7 points (95% confidence interval, -1.2 to -0.1) at 3 weeks, and -0.3 points (95% confidence interval, -0.5 to -0.0) over the first 7 days. Patients receiving the McKenzie method did not show additional effects on global perceived effect, disability, function or on the risk of persistent symptoms. These patients sought less additional health care than those receiving only first-line care (P = 0.002).ConclusionsWhen added to the currently recommended first-line care of acute low back pain, a treatment programme based on the McKenzie method does not produce appreciable additional short-term improvements in pain, disability, function or global perceived effect. However, the McKenzie method seems to reduce health utilization although it does not reduce patient's risk of developing persistent symptoms.Trial RegistrationAustralian New Zealand Clinical Trials Registry: ACTRN12605000032651

Analysis of Patient Outcomes Using the MyoKinesthetic System for the Treatment of Low Back Pain: A Case Series

“…15,43,44 Apeldoorn et al 44 reported a mean baseline score of 6.06 on the NRS, which was lowered to 4.04 following 8 weeks of treatment with Delitto et al's TBC system. Our mean NRS scores were 3.43 at baseline and 0.23 at discharge, and were achieved within 1 month for most patients.…”

Erratum to: Prevalence of sleep disturbance in patients with low back pain

“…Individual patient data were extracted from 13 studies previously conducted by the authors or their colleagues between 2001 and 2009 [22][23][24][25][26][27][28][29][30][31][32]. Studies were eligible for inclusion if they contained the ''I sleep less well because of my back'' item of the Roland and Morris Disability Questionnaire (RMDQ).…”

“…To harmonise data, responses on this questionnaire were multiplied by 1.67. Two studies [23,30,32] used pain items from the Oswestry [34] and CORE [35] questionnaires and, to harmonise the data, responses were multiplied by 2.…”

“…Pain intensity was assessed in seven studies [23,[26][27][28][30][31][32], six of which used a Numerical Rating Scale (NRS), where 0 = no pain and 10 = worst pain imaginable. Three studies [23,24,32] assessed pain intensity using an item from the Short Form 36 (SF-36) [33].…”

Can we predict response to the McKenzie method in patients with acute low back pain? A secondary analysis of a randomized controlled trial

“…Two RCTs have investigated the effects of the McKenzie method in patients with acute nonspecific LBP who were seeking care from a primary care physician [7,8]. Cherkin et al [7] found that patients randomized to treatment with the McKenzie method had only minimally improved outcomes when compared to those receiving an educational booklet.…”