Baseline characteristics did not identify people with low back pain who respond best to a Movement System Impairment-Based classification treatment.

STUDY DESIGN: Secondary analysis of data from a randomized controlled trial. BACKGROUND: Treatment based on the Movement System Impairment-Based classification for chronic low back pain results in the same benefit when compared to other forms of exercise. It is possible that participant's characteristics measured at baseline can identify people with chronic low back pain who would respond best to a treatment based on the Movement System Impairment model. OBJECTIVES: To assess if specific characteristics of people with chronic low back pain measured at baseline can modify the effects of a treatment based on the Movement System Impairment model on pain and disability. METHODS: Four variables assessed at baseline that could potentially modify the treatment effects of the treatment based on the Movement System Impairment model were selected (age, educational status, physical activity status and STarT back tool classification). Separate univariate models were used to investigate a possible modifier treatment effect of baseline participant's characteristics on pain and disability after the treatment. Findings of interaction values above 1 point for the outcome mean pain intensity or above 3 points for disability (Roland Morris questionnaire) were considered clinically relevant. RESULTS: Linear regression analyses for the outcomes of pain and disability did not show interaction values considered clinically relevant for age, educational status, physical activity status and STarT back tool classification. CONCLUSION: Age, educational status, physical activity status and STarT back tool classification did not modify the effects of an 8-week treatment based on the Movement System Impairment model in patients with chronic low back pain. Registered at www.clinicaltrials.gov: NCT02221609 (https://clinicaltrials.gov/ct2/show/NCT02221609).

Pelvic Rotation in Femoroacetabular Impingement Is Decreased Compared to Other Symptomatic Hip Conditions.

Study Design Cross-sectional, case-control design. Background Pelvic movement has been considered a possible discriminating parameter associated with femoroacetabular impingement (FAI) symptom onset. Decreased pelvic rotation has been found during squatting in people with FAI when compared to people with healthy hips. However, it is possible that changes in pelvic movement may occur in other hip conditions because of pain and may not be specific to FAI. Objectives To compare sagittal pelvic rotation during hip flexion and in sitting between people with FAI and people with other symptomatic hip conditions. Methods Thirty people with symptomatic FAI, 30 people with other symptomatic hip conditions, and 20 people with healthy hips participated in the study. Sagittal pelvic rotation was calculated based on measures of pelvic alignment in standing, hip flexion to 45° and 90°, and sitting. Results There were significant differences in sagittal pelvic rotation among the 3 groups in all conditions (P<.05). Post hoc analyses revealed that participants in the symptomatic FAI group had less pelvic rotation during hip flexion to 45° and 90° compared to participants in the other symptomatic hip conditions group and the hip-healthy group (mean difference, 1.2°-1.9°). In sitting, participants in the other symptomatic hip conditions group had less posterior pelvic rotation compared to those in the hip-healthy group (mean difference, 3.9°). Conclusion People with symptomatic FAI have less posterior pelvic rotation during hip flexion when compared to people with other symptomatic hip conditions and those with healthy hips. Level of Evidence Diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(11):957-964. Epub 29 Sep 2016. doi:10.2519/jospt.2016.6713.

Movement System Impairment-Based Classification Versus General Exercise for Chronic Low Back Pain: Protocol of a Randomized Controlled Trial.

BACKGROUND: Low back pain (LBP) is an important health problem in all developed countries and is associated with high levels of disability. Evidence-based clinical practice guidelines usually recommend different physical therapy interventions to manage this condition. However, those interventions usually result in small to moderate clinical effects. Recent studies suggest that interventions based on subgroup classifications may improve the effect sizes compared with rehabilitation programs where the same interventions were applied to all patients. OBJECTIVE: This study will investigate the efficacy of treatment based on a Movement System Impairment (MSI)-based classification model for patients with chronic LBP compared with general exercise. The primary outcomes will be pain intensity and disability at 2 months after randomization. DESIGN: The study is a 2-arm, prospectively registered, randomized controlled trial with a blinded assessor. SETTING: The study setting will be a university physical therapy clinic in Brazil. PARTICIPANTS: A total of 148 individuals with chronic LBP will participate in the study. INTERVENTION: Included individuals will be randomly allocated to participate in an 8-week treatment program based on the MSI-based classification or a general exercise program of stretching and strengthening exercises. MEASUREMENTS: Pain intensity, disability, and global impression of recovery will be assessed by a blinded assessor at baseline and at follow-up appointments after treatment (2 months) and 4 and 6 months after randomization. LIMITATIONS: Therapists will not be blinded. CONCLUSIONS: The results of this study may contribute to a better understanding of the efficacy of treatments based on classification of participants with chronic LBP into subgroups.