BACKGROUND:Back School and McKenzie methods are popular active treatment approaches that include both exercises and information for patients with chronic nonspecific low back pain. OBJECTIVE: The purpose of this study was to compare the effectiveness of Back School and McKenzie methods in patients with chronic nonspecific low back pain. DESIGN: The study was a prospectively registered, 2-arm randomized controlled trial with a blinded assessor. SETTING: The study was conducted in the outpatient physical therapy clinic in São Paulo, Brazil. PATIENTS: The study participants were 148 patients with chronic nonspecific low back pain. INTERVENTIONS: The 4-week treatment program (one session/week) was based on the Back School (delivered to the group) or McKenzie (delivered individually) principles. The participants also were instructed to perform a daily set of home exercises. MEASUREMENTS: Clinical outcomes were assessed at follow-up appointments at 1, 3, and 6 months after randomization. Primary outcome measures were pain intensity (measured by the 0-10 pain numerical rating scale) and disability (measured by the 24-item Roland-Morris Disability Questionnaire) 1 month after randomization. Secondary outcome measures were pain intensity and disability at 3 and 6 months after randomization, quality of life (measured by the World Health Organization Quality of Life-BREF instrument) at 1, 3, and 6 months after randomization, and trunk flexion range of motion measured by an inclinometer at 1 month after randomization. The data were collected by a blinded assessor. RESULTS: Participants allocated to the McKenzie group had greater improvements in disability at 1 month (mean effect=2.37 points, 95% confidence interval=0.76 to 3.99) but not for pain (mean effect=0.66 points, 95% confidence interval=-0.29 to 1.62). No between-group differences were observed for all secondary outcome measures. LIMITATIONS: It was not possible to monitor the home exercise program. Therapists and participants were not blinded. CONCLUSIONS: The McKenzie method (a more resource-intensive intervention) was slightly more effective than the Back School method for disability, but not for pain intensity immediately after treatment in participants with chronic low back pain.
RCT Entities:
BACKGROUND: Back School and McKenzie methods are popular active treatment approaches that include both exercises and information for patients with chronic nonspecific low back pain. OBJECTIVE: The purpose of this study was to compare the effectiveness of Back School and McKenzie methods in patients with chronic nonspecific low back pain. DESIGN: The study was a prospectively registered, 2-arm randomized controlled trial with a blinded assessor. SETTING: The study was conducted in the outpatient physical therapy clinic in São Paulo, Brazil. PATIENTS: The study participants were 148 patients with chronic nonspecific low back pain. INTERVENTIONS: The 4-week treatment program (one session/week) was based on the Back School (delivered to the group) or McKenzie (delivered individually) principles. The participants also were instructed to perform a daily set of home exercises. MEASUREMENTS: Clinical outcomes were assessed at follow-up appointments at 1, 3, and 6 months after randomization. Primary outcome measures were pain intensity (measured by the 0-10 pain numerical rating scale) and disability (measured by the 24-item Roland-Morris Disability Questionnaire) 1 month after randomization. Secondary outcome measures were pain intensity and disability at 3 and 6 months after randomization, quality of life (measured by the World Health Organization Quality of Life-BREF instrument) at 1, 3, and 6 months after randomization, and trunk flexion range of motion measured by an inclinometer at 1 month after randomization. The data were collected by a blinded assessor. RESULTS:Participants allocated to the McKenzie group had greater improvements in disability at 1 month (mean effect=2.37 points, 95% confidence interval=0.76 to 3.99) but not for pain (mean effect=0.66 points, 95% confidence interval=-0.29 to 1.62). No between-group differences were observed for all secondary outcome measures. LIMITATIONS: It was not possible to monitor the home exercise program. Therapists and participants were not blinded. CONCLUSIONS: The McKenzie method (a more resource-intensive intervention) was slightly more effective than the Back School method for disability, but not for pain intensity immediately after treatment in participants with chronic low back pain.
Authors: Patrícia Parreira; Martijn W Heymans; Maurits W van Tulder; Rosmin Esmail; Bart W Koes; Nolwenn Poquet; Chung-Wei Christine Lin; Christopher G Maher Journal: Cochrane Database Syst Rev Date: 2017-08-03
Authors: Scott D Tagliaferri; Maia Angelova; Xiaohui Zhao; Patrick J Owen; Clint T Miller; Tim Wilkin; Daniel L Belavy Journal: NPJ Digit Med Date: 2020-07-09
Authors: Sebastian Straube; Markus Harden; Heiko Schröder; Barbora Arendacka; Xiangning Fan; R Andrew Moore; Tim Friede Journal: Pain Date: 2016-10 Impact factor: 7.926