Predicting a Beneficial Response to Motor Control Training in Patients with Low Back Pain: a Longitudinal Cohort Study

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2019 Jun 30

PMID 31254095

Citations 3

Authors

Julie A Hides

Michael Murphy

Ellen Jang

Linda Blackwell

Margot Sexton

Christopher Sexton

M Dilani Mendis

Affiliations

Soon will be listed here.

Abstract

Purpose: Exercise therapy such as motor control training (MCT) has been shown to reduce pain and disability in people with low back pain (LBP). It is unknown which patients are most likely to benefit. This longitudinal cohort study aimed to: (1) retrospectively examine records from a large cohort of patients who received MCT treatment, (2) identify potentially important predictors of response to MCT and (3) test the predictors on an independent (split) sample derived from the original cohort of patients, using one group to identify the predictors and the other to test them.

Methods: The response of 775 patients with LBP to MCT was classified as 'improved' or 'not improved' based on self-reported change in pain levels and symptoms. Measures were examined for associations with improvement and entered into a logistic regression model to classify patients as low, medium or high benefits of improvement with MCT. The model was tested on an independent sample.

Results: A positive response was seen in patients with: no evidence of scoliosis [OR = 4.0, 95% CI (1.7, 9.6)], LBP without associated groin pain [OR = 2.2, 95% CI (1.0, 5.0)], LBP which was chronic recurrent in nature [OR = 3.1, 95% CI (1.8, 5.3)] and poor results on muscle testing of the multifidus muscle [OR = 2.0, 95% CI (1.1, 3.7)]. Testing on an independent sample confirmed that patients could be classified into benefit groups.

Conclusions: This study provides a first step towards assisting clinicians to select patients most likely to respond to MCT. These slides can be retrieved under Electronic Supplementary Material.

Citing Articles

Electromyography of the Multifidus Muscle in Horses Trotting During Therapeutic Exercises.

Ursini T, Shaw K, Levine D, Richards J, Adair H Front Vet Sci. 2022; 9:844776.

PMID: 35692292 PMC: 9184818. DOI: 10.3389/fvets.2022.844776.

Understanding regional activation of thoraco-lumbar muscles in chronic low back pain and its relationship to clinically relevant domains.

Serafino F, Trucco M, Occhionero A, Luigi Cerone G, Chiarotto A, Vieira T BMC Musculoskelet Disord. 2021; 22(1):432.

PMID: 33975570 PMC: 8114502. DOI: 10.1186/s12891-021-04287-5.

Motor Control Stabilisation Exercise for Patients with Non-Specific Low Back Pain: A Prospective Meta-Analysis with Multilevel Meta-Regressions on Intervention Effects.

Niederer D, Engel T, Vogt L, Arampatzis A, Banzer W, Beck H J Clin Med. 2020; 9(9).

PMID: 32971921 PMC: 7564352. DOI: 10.3390/jcm9093058.

References

Searle A, Spink M, Ho A, Chuter V . Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015; 29(12):1155-67. DOI: 10.1177/0269215515570379. View

Hides J, Donelson R, Lee D, Prather H, Sahrmann S, Hodges P . Convergence and Divergence of Exercise-Based Approaches That Incorporate Motor Control for the Management of Low Back Pain. J Orthop Sports Phys Ther. 2019; 49(6):437-452. DOI: 10.2519/jospt.2019.8451. View

Hides J, Stanton W, Mendis M, Gildea J, Sexton M . Effect of motor control training on muscle size and football games missed from injury. Med Sci Sports Exerc. 2011; 44(6):1141-9. DOI: 10.1249/MSS.0b013e318244a321. View

Henschke N, Maher C, Refshauge K, Herbert R, Cumming R, Bleasel J . Characteristics of patients with acute low back pain presenting to primary care in Australia. Clin J Pain. 2009; 25(1):5-11. DOI: 10.1097/AJP.0b013e3181817a8d. View

Hides J, Stanton W, Mendis M, Sexton M . The relationship of transversus abdominis and lumbar multifidus clinical muscle tests in patients with chronic low back pain. Man Ther. 2011; 16(6):573-7. DOI: 10.1016/j.math.2011.05.007. View

Scott J, Huskisson E . Graphic representation of pain. Pain. 1976; 2(2):175-84. View

Stevens M, Lin C, Maher C . The Roland Morris Disability Questionnaire. J Physiother. 2015; 62(2):116. DOI: 10.1016/j.jphys.2015.10.003. View

Florindo A, Latorre M, Dos Santos E, Negrao C, Azevedo L, Segurado A . Validity and reliability of the Baecke questionnaire for the evaluation of habitual physical activity among people living with HIV/AIDS. Cad Saude Publica. 2006; 22(3):535-41. DOI: 10.1590/s0102-311x2006000300008. View

Nielsen A, Hestbaek L, Vach W, Kent P, Kongsted A . Latent class analysis derived subgroups of low back pain patients - do they have prognostic capacity?. BMC Musculoskelet Disord. 2017; 18(1):345. PMC: 5551030. DOI: 10.1186/s12891-017-1708-9. View

10.

Hides J, Gilmore C, Stanton W, Bohlscheid E . Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects. Man Ther. 2006; 13(1):43-9. DOI: 10.1016/j.math.2006.07.017. View

11.

Ostelo R, Deyo R, Stratford P, Waddell G, Croft P, Von Korff M . Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976). 2008; 33(1):90-4. DOI: 10.1097/BRS.0b013e31815e3a10. View

12.

Hides J, Richardson C, Jull G . Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine (Phila Pa 1976). 1996; 21(23):2763-9. DOI: 10.1097/00007632-199612010-00011. View

13.

Wallwork T, Stanton W, Freke M, Hides J . The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Man Ther. 2008; 14(5):496-500. DOI: 10.1016/j.math.2008.09.006. View

14.

Hodges P, Galea M, Holm S, Holm A . Corticomotor excitability of back muscles is affected by intervertebral disc lesion in pigs. Eur J Neurosci. 2009; 29(7):1490-500. DOI: 10.1111/j.1460-9568.2009.06670.x. View

15.

Hodges P, James G, Blomster L, Hall L, Schmid A, Shu C . Multifidus Muscle Changes After Back Injury Are Characterized by Structural Remodeling of Muscle, Adipose and Connective Tissue, but Not Muscle Atrophy: Molecular and Morphological Evidence. Spine (Phila Pa 1976). 2015; 40(14):1057-71. DOI: 10.1097/BRS.0000000000000972. View

16.

Zhao W, Kawaguchi Y, Matsui H, Kanamori M, Kimura T . Histochemistry and morphology of the multifidus muscle in lumbar disc herniation: comparative study between diseased and normal sides. Spine (Phila Pa 1976). 2000; 25(17):2191-9. DOI: 10.1097/00007632-200009010-00009. View

17.

Hides J, Stanton W, McMahon S, Sims K, Richardson C . Effect of stabilization training on multifidus muscle cross-sectional area among young elite cricketers with low back pain. J Orthop Sports Phys Ther. 2008; 38(3):101-8. DOI: 10.2519/jospt.2008.2658. View

18.

Nitz A, Peck D . Comparison of muscle spindle concentrations in large and small human epaxial muscles acting in parallel combinations. Am Surg. 1986; 52(5):273-7. View

19.

Hides J, Belavy D, Stanton W, Wilson S, Rittweger J, Felsenberg D . Magnetic resonance imaging assessment of trunk muscles during prolonged bed rest. Spine (Phila Pa 1976). 2007; 32(15):1687-92. DOI: 10.1097/BRS.0b013e318074c386. View