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New Data: Patients Who Respond Best to Back Treatment

Elizabeth Hofheinz, M.P.H., M.Ed. • Fri, November 17th, 2017

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New research from Australia is pointing towards answers to the question, “Exactly how will a given patient respond to treatment for low back pain?”

Their study, “Who Benefits Most from Individualized Physiotherapy or Advice for Low Back Disorders? A Preplanned Effect Modifier Analysis of a Randomized Controlled Trial,” appears in the November 1, 2017 edition of Spine.

Andrew Hahne, Ph.D., with the Low Back Research Team at LaTrobe University in Melbourne, Australia, told OTW, “Clinicians and researchers usually only know the ‘average’ treatment benefit that a person could expect from a particular intervention. However, there are always patients who will respond much better or much worse than the average. Being able to predict more precisely how a given patient will respond to treatment is extremely helpful for deciding whether that treatment is worthwhile.”

“Our research aimed to find characteristics of patients with low back pain and/or sciatica who respond best to 10 sessions of individualized physiotherapy compared to two sessions of guideline-based advice. We hoped that this would assist clinicians to choose the most suitable treatment for individuals with this condition by looking beyond the ‘averages’ and striving to match the right treatment with the right patient.”

“Most studies relating to prognosis only contain one group of participants. A limitation of that study design is that, without a control group, it is impossible to know if prognostic characteristics apply broadly or whether they are specific to a particular treatment.”

“Our study used a randomized controlled trial to find characteristics among people with back pain that predicted a better response to individualized physiotherapy compared to guideline-based advice. This is the only study design that allows recommendations to be made about which patients benefit most from a particular treatment relative to another, making it very useful for treatment selection decisions.”

“Our findings were highly convincing and consistent.”

“We found that patients with low back pain who had a longer duration of symptoms, higher back pain scores, and higher scores on the Orebro Musculoskeletal Pain Screening Questionnaire (indicative of a presentation with more complex biopsychosocial barriers to recovery) responded especially well to individualized physiotherapy but struggled if they received only guideline-based advice.”

“People with low scores on all of those characteristics seemed to receive a good result with either of these treatment options.”

“These results allow greater targeting of care to patients with low back pain or sciatica. Comprehensive individualized physiotherapy programs should be targeted especially towards those patients with more persistent symptoms, higher back pain levels, and more complex barriers to recovery, while guideline based advice is likely to be sufficient for those who score low on all of these characteristics.”

“This study is an example of how healthcare resources can be targeted to where they are most likely to be beneficial by looking beyond ‘average’ treatment effects and striving to identify more precisely how an individual patient is likely to respond to a particular treatment relative to another. To achieve this, large randomized controlled trials are needed that compare genuine treatment options with the aim of determining not only the average treatment effect, but also who benefits most from each intervention.”

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