Effectiveness of Directional Preference to Guide Management of Low Back Pain in Canadian Armed Forces Members: A Pragmatic Study

Exercise plays an important role in rehabilitating people with chronic low back pain. Aerobic exercise and resistance training are general exercise strategies to manage chronic low back pain, but these strategies require longer intervention period to achieve clinical outcomes in pain reduction and functional improvements. Directional preference is recognised as an important exercise strategy in managing low back pain. The Clinical Pilates exercise method leverages on the directional preference of an individual to achieve clinical outcomes faster. Clinical Pilates is a hybrid of two of the best exercise interventions for low back pain, which are general Pilates and the McKenzie method. Due to the scarcity of Clinical Pilates literature, a review of its theory and studies was undertaken to provide a structured guide to the technique in managing people with chronic low back pain. Hypothetical algorithms are developed to support translation into clinical practice and future research studies. These algorithms are useful in the management of complex cases involving multiple directional trauma. Although limited, current evidence suggests that the Clinical Pilates exercise method is safe and provides faster functional recovery in the early stage of rehabilitation and similar longer term outcomes as general exercises.

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A randomized clinical trial comparing the McKenzie method and motor control exercises in people with chronic low back pain and a directional preference: 1-year follow-up

Physiotherapy ◽

10.1016/j.physio.2018.12.004 ◽

2019 ◽

Vol 105 (4) ◽

pp. 442-445

Author(s):

Mark H. Halliday ◽

Evangelos Pappas ◽

Mark J. Hancock ◽

Helen A. Clare ◽

Rafael Z. Pinto ◽

...

Keyword(s):

Clinical Trial ◽

Low Back Pain ◽

Motor Control ◽

Back Pain ◽

Randomized Clinical Trial ◽

Chronic Low Back Pain ◽

Low Back ◽

Directional Preference ◽

Mckenzie Method

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The Influence of Centralization and Directional Preference on Spinal Control in Patients With Nonspecific Low Back Pain

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2016.6158 ◽

2016 ◽

Vol 46 (4) ◽

pp. 258-269 ◽

Cited By ~ 5

Author(s):

Adri T. Apeldoorn ◽

Hans van Helvoirt ◽

Hanneke Meihuizen ◽

Henk Tempelman ◽

David Vandeput ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Low Back ◽

Directional Preference ◽

Spinal Control

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Pain pattern classification and directional preference are associated with clinical outcomes for patients with low back pain

Journal of Manual & Manipulative Therapy ◽

10.1080/10669817.2017.1343538 ◽

2017 ◽

Vol 26 (1) ◽

pp. 18-24 ◽

Cited By ~ 9

Author(s):

Richard Yarznbowicz ◽

Minjing Tao ◽

Alexa Owens ◽

Matt Wlodarski ◽

Jonathan Dolutan

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Clinical Outcomes ◽

Pattern Classification ◽

Low Back ◽

Pain Pattern ◽

Directional Preference

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Exploratory study for clinical signs of MODIC changes in patients with low-back pain in the Netherlands armed forces

Chiropractic & Manual Therapies ◽

10.1186/s12998-018-0229-4 ◽

2019 ◽

Vol 27 (1) ◽

Cited By ~ 1

Author(s):

Peter van der Wurff ◽

Tom Vredeveld ◽

Caroline van de Graaf ◽

Rikke K. Jensen ◽

Tue S. Jensen

Keyword(s):

Low Back Pain ◽

Back Pain ◽

The Netherlands ◽

Exploratory Study ◽

Clinical Signs ◽

Armed Forces ◽

Modic Changes ◽

Low Back

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Prevalence and Associated Factors of Low Back Pain Among Physicians Working at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.787 ◽

2019 ◽

Vol 7 (17) ◽

pp. 2807-2813 ◽

Cited By ~ 1

Author(s):

Bashayr Al-Ruwaili ◽

Tahani Khalil

Keyword(s):

Saudi Arabia ◽

Low Back Pain ◽

Back Pain ◽

Armed Forces ◽

Cross Sectional Study ◽

Health Care Facilities ◽

Considerable Proportion ◽

Low Back ◽

Cross Sectional ◽

Absence From Work

BACKGROUND: Low back pain is a common presenting symptom among workers in primary health care facilities, including physicians. AIM: This study aimed to identify the magnitude, determinants and sequence of the problem of low back pain among physicians working at the King Salman Armed Forces hospital, Tabuk, Saudi Arabia. METHODS: A cross-sectional study was carried out among physicians who are working at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia. A previously validated self-administered questionnaire was utilised for data collection including demographic information and data related to low back pain and its characteristics and outcome. RESULTS: The study included 254 physicians. Their age ranged between 23 and 66 with a mean ± SD of 36.0 ± 9.3 years. Almost two-thirds (66.9%) were males. Most of the physicians (76.4%) ever had LBP whereas 70.5% had LBP in the last 12 months. The only significant factor associated with LBP in the past 12 months was physicians` speciality as all ophthalmologists and majority of emergency physicians and anaesthesia/intensive care physicians (88.9%) compared to only 14.3% of nephrologists and neurologists expressed LBP in the last 12 months. Overall, the association between physicians’ speciality and a history of LBP in the last 12 months was statistically significant, p = 0.014. Absence from work because of LBP in the last 3 months was mentioned by 15% of physicians. CONCLUSION: Low back pain is a very common health problem among physicians working at the King Salman Armed Forces hospital, Saudi Arabia. A considerable proportion of them was absent from work because of LBP.

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Efficacy of Directional Preference Management for Low Back Pain: A Systematic Review

Physical Therapy ◽

10.2522/ptj.20100251 ◽

2012 ◽

Vol 92 (5) ◽

pp. 652-665 ◽

Cited By ~ 33

Author(s):

Luke D. Surkitt ◽

Jon J. Ford ◽

Andrew J. Hahne ◽

Tania Pizzari ◽

Joan M. McMeeken

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Specific Treatment ◽

Work Participation ◽

Low Back ◽

Short Term ◽

High Quality ◽

Directional Preference ◽

Efficacy Of Treatment

BackgroundProviding specific treatment based on symptom response for people with low back pain (LBP) and a directional preference (DP) is a widely used treatment approach. The efficacy of treatment using the principles of directional preference management (DPM) for LBP is unclear.ObjectiveThe purpose of this study was to determine the efficacy of treatment using the principles of DPM for people with LBP and a DP.MethodsComputer databases were searched for randomized controlled trials (RCTs) published in English up to January 2010. Only RCTs investigating DPM for people with LBP and a DP were included. Outcomes for pain, back specific function, and work participation were extracted.ResultsSix RCTs were included in this review. Five were considered high quality. Clinical heterogeneity of the included trials prevented meta-analysis. GRADE quality assessment revealed mixed results; however, moderate evidence was identified that DPM was significantly more effective than a number of comparison treatments for pain, function, and work participation at short-term, intermediate-term, and long-term follow-ups. No trials found that DPM was significantly less effective than comparison treatments.ConclusionsAlthough this systematic review showed mixed results, some evidence was found supporting the effectiveness of DPM when applied to participants with a DP, particularly at short-term and intermediate-term follow-ups. Further high-quality RCTs are warranted to evaluate the effect of DPM applied to people with LBP and a DP.

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Identifying Patients With Chronic Low Back Pain Who Respond Best to Mechanical Diagnosis and Therapy: Secondary Analysis of a Randomized Controlled Trial

Physical Therapy ◽

10.2522/ptj.20150295 ◽

2016 ◽

Vol 96 (5) ◽

pp. 623-630 ◽

Cited By ~ 14

Author(s):

Alessandra Narciso Garcia ◽

Luciola da Cunha Menezes Costa ◽

Mark Hancock ◽

Leonardo Oliveira Pena Costa

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Treatment Effect ◽

Secondary Analysis ◽

Low Back ◽

Effect Modifier ◽

Back School ◽

Diagnosis And Therapy ◽

Directional Preference

Background “Mechanical Diagnosis and Therapy” (MDT) (also known as the McKenzie method), like other interventions for low back pain (LBP), has been found to have small effects for people with LBP. It is possible that a group of patients respond best to MDT and have larger effects. Identification of patients who respond best to MDT compared with other interventions would be an important finding. Objective The purpose of the study was to investigate whether baseline characteristics of patients with chronic LBP, already classified as derangement syndrome, can identify those who respond better to MDT compared with Back School. Methods This study was a secondary analysis of data from a previous trial comparing MDT with Back School in 148 patients with chronic LBP. Only patients classified at baseline assessment as being in the directional preference group (n=140) were included. The effect modifiers tested were: clear centralization versus directional preference only, baseline pain location, baseline pain intensity, and age. The primary outcome measures for this study were pain intensity and disability at the end of treatment (1 month). Treatment effect modification was evaluated by assessing the group versus predictor interaction terms from linear regression models. Interactions ≥1.0 for pain and ≥3 for disability were considered clinically important. Results Being older met our criteria for being a potentially important effect modifier; however, the effect occurred in the opposite direction to our hypothesis. Older people had 1.27 points more benefit in pain reduction from MDT (compared with Back School) than younger participants after 1 month of treatment. Limitations The sample (n=140) was powered to detect the main effects of treatment but not to detect the interactions of the potential treatment effect modifiers. Conclusions The results of the study suggest older age may be an important factor that can be considered as a treatment effect modifier for patients with chronic LBP receiving MDT. As the main trial was not powered for the investigation of subgroups, the results of this secondary analysis have to be interpreted cautiously, and replication is needed.

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