Preliminary development of a clinical prediction rule for specific motor control exercise in adults with chronic low back pain

Gibbons SGT (2019) Preliminary development of a clinical prediction rule for specific motor control exercise in adults with chronic low back pain,. Proceedings of: The 10^th Interdisciplinary World Congress on Low Back Pain. October 28-31, 2019; Antwerp, Brussels

Introduction

Chronic low back pain (CLBP) is an enormous burden on society. There is no standard treatment and numerous options are available. There is evidence for motor control interventions (MCI). These include specific segmental stabilization exercises (SSE) (e.g. abdominal hollowing for a bias of transverus abdominis) and specific movement pattern control exercises (SME) which requires patients to cognitively alter and control their movement patterns (e.g. keeping their lumbar spine neutral and flexing forward from the hips). There is little evidence to guide clinicians in choosing the most effective type of exercise for an individual patient. 

Purpose/Aim

The purpose of this paper was to assess is it was possible to derive variables that can be used to identify subjects with CLBP who are likely to have a successful short term outcome with MCI.

Materials and Methods

34 variables were derived from a three stage process involving a literature review and contacting experts. 80 consecutive subjects (32M/48F) with CLBP who met the inclusion criteria were included and completed the baseline questionnaires and assessment. 38 did not meet the inclusion criteria and 6 declined participation.  They were treated with SMCE at the discretion of the treating therapist. They attended 14 sessions over 12 weeks. Subjects were dichotomized into successful or non successful outcome based on a score of +5 or greater on the Global Rating of Change (GROC) score. The mean change scores were calculated for the Numerical Pain Rating Scale and Roland Morris Disability Questionnaire. These were analyzed with independent t test to determine of a group difference existed with the GROC score. Individual variables were tested for univariate relationship with the GROC reference criterion using independent-samples t tests for continuous variables and chi-square tests for categorical variables.  Variables with a significance level of P < .10 were retained as potential prediction.  These were plotted as a receiver operator characteristic curve and sensitivity and specificity values were calculated for all possible cut off points. Positive and negative likelihood ratios were then calculated for variables with a significant relationship with the reference criterion of successful outcome. Step wise logistic regression was then used to form the most prudent combination of predictors for identifying subjects with CLBP that are likely to respond favourably to SMCE.

Results

55 subjects (25M/30F) had a successful outcome. Three variables predicted short term success with SMCE. These included an Orebro Musculoskeletal Screening Questionnaire score under 64 (OR: 4.35); Behavioral Screening Questionnaire is negative (OR: 47.88) and the Motor Control Abilities Questionnaire (MCAQ) (OR:125).

Conclusion(s)

The MCAQ is a screening tool developed to predict if people can learn SSE and SME. This was the strongest predictor of any item.  A successful short term outcome may be achieved in CLBP with MCI if psychosocial factors are ruled out and patients have the ability to learn the learn the exercises. This model requires testing in a clinical trial.

Keywords

Clinical prediction rule, chronic low back pain, spinal stabilization, motor control, specific exercise