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 10th 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
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