Specific Directional Exercises for Patients with Low Back Pain: A Case Series
Notice bibliographique
Résumé
PURPOSE: To determine whether outcomes could be changed after poor response to non-specific exercise therapy when the prescription was changed to specific, directional-preference exercises (McKenzie method). METHODS: Patients who participated in a randomized clinical trial (RCT) and the alternative care phase immediately following formed the cohort for this case series. In an earlier RCT, patients with directional preference were randomized to exercises/advice matched to their individual directional preference or to one of two unmatched protocols. The primary inclusion criterion for our case series was patient reports of being unchanged or worse following 2 weeks' treatment in the RCT. The secondary inclusion criterion was patient requests for "a change to one of the other stretching protocols to see if I can achieve better pain control." Patients meeting either of these criteria were offered matched exercises/advice if they had not previously received this intervention. Two-way repeated-measures ANOVA and McNemar tests compared outcomes during two consecutive time intervals: baseline to 2 weeks and 2 weeks to discharge. Dropouts were included in the intention-to-treat analysis. RESULTS: Four patients from the matched group met the primary inclusion criterion of "unchanged" (none reported being worse); 10 additional patients requested alternative treatment for better pain control (secondary criterion). Eighty-five patients from the two unmatched treatment groups met all the inclusion criteria, and an additional 22 patients met only the secondary criterion. These patients were offered matched treatment, and 96 consented. Those reporting improvement or resolution of symptoms were 22 % in the first two weeks of unmatched care (during the RCT) compared to 84 % with matched care. Statistically significant and clinically meaningful changes occurred in all outcomes (p < 0.001) after receiving matched care, compared to clinically unimportant changes with previous unmatched care during the RCT. CONCLUSIONS: Poor outcomes from non-specific/unmatched exercise protocols appeared to reverse when patients with directional preference were given sub-group-matched, direction-specific exercises. Because of the limitations of our study design, replication with a control group and longer-term follow-up are required to validate the findings.
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».