Article

Back School and McKenzie methods are popular active treatment
approaches that include both exercises and information for patients with chronic
nonspecific low back pain.
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 Sao 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.

Langue : ANGLAIS