Outcomes are not different for patient-matched vs. non-matched treatment in subjects with chronic, recurrent low back pain

Classification schemas for low back pain (LBP), like the Treatment Based Classification and the Movement System Impairment schemas, use common clinical features to subgroup patients with LBP and are said to improve treatment outcomes. The aim of this study was to investigate whether providing matched treatments based on patient specific clinical features led to superior treatment outcomes compared to an unmatched treatment for subjects with chronic, recurrent LBP. Participants (n=124) with LBP (≥ 12 months) with or without recurrences underwent a standardized clinical exam to group them into one of 2 strata: (1) ineligible or (2) eligible for stabilization exercises based on the Treatment Based Classification schema. Subjects underwent additional clinical tests to assign them to one of the 5 possible Movement System Impairment categories. Questionnaires were collected electronically at: Week 0, prior to treatment; Week 7 (after the 6 weekly, one hour treatment sessions); and 12 months. Using the Oswestry Disability Index (0-100) and the Numeric Pain Rating Scale (0-10), the primary analysis was performed using the intention-to-treat principle. Secondary outcomes included fear-avoidance beliefs as well as psychosocial, work related and general health status. After subjects were categorized based on their particular clinical features using both the Treatment Based Classification and Movement System Impairment schemas, they were randomized into one of two treatments using a 3:1 ratio for matched or unmatched treatments. The treatments were (1) trunk stabilization exercise, or (2) Movement System Impairment-directed exercises. The study was funded by National Institutes of Health (NCMRR/R01HD040909; $1,485,000). There are no study specific conflicts of interest to report. Of the patients allocated to treatment for this study, 76 received a matched treatment and 25 were given an unmatched treatment. Following treatment, both groups exhibited a statistically significant improvement in the primary outcome measures and almost all of the secondary measures; however, the matched treatment group did not demonstrate superior outcomes at Week 7 or 12 months, except on one of the secondary measures (Graded Chronic Pain Scale – Disability Scale) (P=0.01).

This study found that providing a matched treatment based on either the Treatment Based Classification or the Movement System Impairment classification schemas didn’t improve treatment outcomes in comparison to an unmatched treatment for patients with chronic LBP, except on one secondary disability measure.

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