Effectiveness of Directional Preference to Guide Management of Low Back Pain in Canadian Armed Forces Members: A Pragmatic Study
Bibliographic record
Abstract
INTRODUCTION: Low-back pain (LBP) is a leading cause for disability in military personnel. Consequently, effective management strategies are required to maintaining operational capabilities. Physical therapy clinical practice guidelines recommend the use of directional preference (DP) to guide management. The effectiveness of this approach has not been tested in military personnel using a pragmatic study design. Pragmatic studies are ideal to inform clinicians and policymakers about the usefulness of proven interventions in real-life clinical conditions. The purpose of this study was therefore to determine, in clinical practice, the effectiveness of a management approach guided by DP vs. usual care (UC) physical therapy in Canadian Armed Forces (CAF) members with LBP. MATERIAL AND METHODS: A pragmatic study was conducted among 44 consecutive CAF members with LBP who received management guided by DP (n = 22) or UC (n = 22). Outcomes were pain intensity (primary outcome), pain location and frequency, perceived disability, medication use, perceived global effect (pain, function, overall status), work loss, and health care utilization. The effectiveness of the intervention was assessed at 1-month and 3-months follow-up. RESULTS: Statistically significant differences favoring the DP group were observed for pain intensity (Δ 1 month: 1.9/10; 95% confidence interval [CI]; 0.97-2.89; Δ 3 months: 1.3/10; 95% CI: 0.35-2.31), pain location at 1 month (54.5% vs. 19.0%; p = 0.02) and 3 months (68.2% vs. 38.1%; p = 0.01), disability (Δ 1 month: 4.3/24; 95% CI: 2.12-6.38; Δ 3 months: 3.5/24; 95% CI; 1.59-5.33), perceived global effect at 1 month (pain: 86.4% vs. 57.1%; function: 81.8% vs. 47.6%; overall status: 86.4% vs. 57.1%) and 3 months (pain: 95.5% vs. 71.1%; overall status: 95.5% vs. 66.7%) with p values < 0.05, and improvement in work status at 3 months (54.5% vs. 23.8%; p = 0.04). CONCLUSION: DP-guided management appears more effective than UC physical therapy to reduce pain and improve function in CAF members with LBP. Rapid improvements and the patient's ability to self-manage may prove especially advantageous in deployed settings. Our findings are particularly useful to inform military policymakers and clinicians on optimal management for CAF members.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".