Article

OBJECTIVE: To compare a protocol of evidence-based conservative care with usual
care for acute nonspecific low back pain (LBP) of less than 6 weeks' duration.
DESIGN: Parallel-group randomized trial. SETTING:
Three practices in the United
Kingdom. PARTICIPANTS: Convenience sample of 149 eligible patients were invited
to participate in the study, with 118 volunteers being consented and randomly
allocated to a treatment group. INTERVENTIONS: The experimental group received
evidence-based treatments for acute nonspecific LBP as prescribed in a structured
protocol of care developed for this study. The control group received usual
conservative care. Participants in both groups could receive up to 7 treatments
over a 4-week period. MAIN OUTCOME MEASURES: Oswestry Low Back Disability Index
(ODI), visual analog scale (VAS), and Patient Satisfaction Questionnaire,
alongside estimation of clinically meaningful outcomes. RESULTS: Total dropout
rate was 14% (n=16), with 13% of data missing. Missing data were replaced using a
multiple imputation method. Participants in both groups received an average of 6
treatments. There was no statistically significant difference in disability (ODI)
scores at the end of week 4 (P=.33), but there was for pain (VAS) scores
(P<.001). Interestingly, there were statistically significant differences between
the 2 groups for both disability and pain measures at the midpoint of the
treatment period (P<.001). Patient satisfaction with care was equally high (85%)
in both groups. Minimally clinically important differences in scores and number
needed to treat scores (NNT<6) indicated that the experimental treatment
(protocol of care) offered a clinically meaningful benefit over the control
treatment (usual care), particularly at the midpoint of the treatment period.
CONCLUSIONS: Overall, the 2 treatment groups were similar based on primary or
secondary outcome measure scores for the full treatment period (4 weeks, with up
to 7 treatments). However, there were statistically significant and clinically
meaningful differences in both disability and pain scores at week 2 (midpoint)
with 4 treatments, suggesting that the protocol of care had a more rapid effect
than usual care.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS