Eur J Phys Rehabil Med. 2012 (Sep); 48 (3): 371–378
Cecchi F, Negrini S, Pasquini G, Paperini A, Conti A. A, Chiti M,
Zaina F, Macchi C, Molino-Lova R.
Fondazione Don Carlo Gnocchi,
Outpatient Rehabilitation Department,
BACKGROUND:   Recent studies on chronic low back pain (cLBP) rehabilitation suggest that predictors of treatment outcome may be differ according to the considered conservative treatment.
AIM:   To identify predictors of response to back school (BS), individual physiotherapy (IP) or spinal manipulation (SM) for cLBP.
POPULATION:   outpatients with cLBP.
SETTING:   Outpatient rehabilitation department.
DESIGN:   Retrospective analysis from a randomized trial.
METHODS:   Two hundred and ten patients with cLBP were randomly assigned to either BS, IP or SM; the Roland Morris Disability Questionnaire (RM) was assessed before and after treatment: those who decreased their RM score <2.5 were considered non-responders. Baseline potential predictors of outcome included demographics, general and cLBP history, life satisfaction.
RESULTS:   Of the 205 patients who completed treatment (140/205 women, age 58+14 years), non-responders were 72 (34.2%). SM showed the highest functional improvement and the lowest non-response rate. In a multivariable logistic regression, lower baseline RM score (OR 0.82, 95% CI 0.76-0.89, P<0.001) and received treatment (OR 0.32, 95% CI 0.21-0.50, P<0.001) were independent predictors of non-response. Being in the lowest tertile of baseline RM score (<6) predicted non response to treatment for back school (BS) and individual physiotherapy (IP), but not for spinal manipulation (SM) (same risk for all tertiles).
CONCLUSIONS:   In our patients with cLBP lower baseline pain-related disability predicted non-response to physiotherapy, but not to spinal manipulation.
CLINICAL REHABILITATION IMPACT:   Our results suggest that, independent form other characteristics, patients with cLBP and low pain-related disability should first consider spinal manipulation as a conservative treatment.