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Purpose: To investigate the effects of physical therapy interventions of the hip on outcomes of pain and disability in patients with low back pain., Data Sources: PubMed, CINAHL, Scopus, Web of Science, and SPORTDiscus were searched from inception to 18 April 2018., Study Selection/eligibility Criteria: The following inclusion criteria were required to be met: (1) randomized controlled trials; (2) populations with diagnosed low back pain; and (3) interventions that target the hip joint. Two researchers independently screened titles, abstracts, and full texts for inclusion., Data Extraction and Synthesis: Data was extracted for information related to patient demographics, specific interventions, and outcomes assessed. When studies demonstrated homogeneity on outcome measures, the mean differences or standardized mean differences with 95% confidence interval were calculated and pooled in a meta-analysis., Results: Six articles with a total of 387 participants were included in the review and meta-analysis. Specific intervention categories that were found in the search included: hydrotherapy (n = 1); exercise therapy (n = 4); and manual therapy (n = 2). Trivial effect size was found for the pain outcomes and small effect size was found for disability. All of these studies were found to have high risk of bias according the Cochrane Risk of Bias tool., Conclusion: The meta-analyses from the pooled studies did not result in statistically significant reductions in either pain or disability with the addition of hip-targeted physical therapy interventions to patients with LBP., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Early change is commonly assessed for manual therapy interventions and has been used to determine treatment appropriateness. However, current studies have only explored the relationship of between or within-session changes and short-/medium-term outcomes. The goal of this study was to determine whether pain changes after two weeks of pragmatic manual therapy could predict those participants with chronic low back pain who demonstrate continued improvements at 6-month follow-up. This study was a retrospective observational design. Univariate logistic regression analyses were performed using a 33% and a 50% pain change to predict improvement. Those who experienced a ≥33% pain reduction by 2 weeks had 6.98 (95% CI = 1.29, 37.53) times higher odds of 50% improvement on the GRoC and 4.74 (95% CI = 1.31, 17.17) times higher odds of 50% improvement on the ODI (at 6 months). Subjects who reported a ≥50% pain reduction at 2 weeks had 5.98 (95% CI = 1.56, 22.88) times higher odds of a 50% improvement in the GRoC and 3.99 (95% CI = 1.23, 12.88) times higher odds of a 50% improvement in the ODI (at 6 months). Future studies may investigate whether a change in plan of care is beneficial for patients who are not showing early improvement predictive of a good long-term outcome.

Study Design: Randomized controlled trial., Background: Several studies that have investigated the effects of a therapist-selected versus a randomly assigned segmental approach have looked at immediate effects only for pain-related outcomes., Objectives: To examine differences in outcomes following a therapist-selected nonthrust manipulation versus a prescriptively selected nonthrust manipulation in subjects with low back pain., Methods: Subjects with mechanically producible low back pain were randomly treated with nonthrust manipulation in a therapist-selected approach or a prescriptively selected approach. All subjects received a standardized home exercise program. Outcome measures included pain, disability, global rating of change, and patient acceptable symptom state. Analyses of covariance, chi-square tests, and Mann-Whitney U tests were used to determine differences between groups., Results: Sixty-three subjects were tracked for 6 months, during which subjects in both groups significantly improved. There were no differences between groups in pain, disability, or patient acceptable symptom state scores at 6 months. There was a significant difference in global rating of change scores favoring the therapist-selected manipulation group at 6 months., Conclusion: This study measured long-term differences between a prescriptively selected nonthrust manipulation and a therapist-selected approach to nonthrust manipulation. In pain, disability, and patient acceptable symptom state there were no differences in outcomes, findings similar to studies of immediate effects. After 6 months, perceived well-being was significantly higher for those in the therapist-selected treatment group. The study was registered at ClinicalTrials.gov (NCT01940744)., Level of Evidence: Therapy, level 1b.

Subjective history questions/self-report items are commonly used to triage the patient with low back pain and related leg symptoms. However the value of the history taking process for decision-making to identify common classifications/diagnosis for patients presenting with low back related leg pain (LBRLP) have not been considered. The purpose of this study was to investigate the diagnostic accuracy of self-report items/history-taking questions used to identify patients with LBRLP. Eligible studies included: 1)subjects with low back pain AND related lower extremity pain, 2)details of subjective examination/self-report items, 3)cohort, prospective/longitudinal studies, and randomized control trials, 4)use of statistical reporting, 5)an acceptable reference standard. Quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies 2. A synthesis of history items that met the threshold for at least a small shift in the likelihood of the condition with a +LR ≥ 2 or -LR ≤ 0.5 were reported. Conditions commonly reported in the literature: lumbar spinal stenosis, lumbosacral nerve root compression/radiculopathy, disc herniation and neurophysiological low back pain ± leg pain. Eleven studies met the inclusion criteria. This is the first systematic review of diagnostic accuracy studies that examined only the history-taking items for their ability to identify LBRLP conditions. Clustering key items may provide a more precise clinical picture necessary to detect and treat a patient's presentation. History questions formed within the interview and their contributing value for decision-making remain understudied. There is a need for better designs to determine a more accurate diagnostic power to identify conditions with LBRLP., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objectives: The purpose of this study was to compare the outcomes of patients with low back pain who had a matched, unmatched, or were indifferent with their pretreatment expectation/preference to the manual therapy thrust or nonthrust intervention. A secondary purpose was to explore baseline patient characteristics affiliated with a preference of manual therapy treatment type (thrust or nonthrust manipulation)., Methods: The study is a secondary analysis of a prospective randomized controlled trial that enrolled 149 patients with low back pain, from 16 distinct outpatient physical therapy practices within the United States. Patient's pretreatment expectations were identified before randomization. The intervention included manual therapy (thrust or nonthrust manipulation) with a standardized exercise program, which was carried out for 2 treatment sessions. Six outcomes captured the constructs of (a) disability, (b) pain perception, (c) care intensity, (d) fear avoidance behaviors, and (e) perception of extent of recovery. Descriptive statistics, analysis of variance (and Tukey, a post hoc test), Fisher exact test, and a multivariate logistic regression analysis were used for analysis., Results: There were no statistical differences in any of the 6 dedicated outcomes measures between the matched, unmatched, and no preference groups. Therapist-determined patient "irritability" was associated with patient preference of nonthrust treatment, and higher body mass index was associated with patient preference of thrust treatment., Conclusions: This study shows that patients demonstrated no statistical difference in disability or pain outcome measures when matched, unmatched, or indifferent to the intervention., (Copyright © 2013 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Objective: Our goal was to create a parsimonious combination of the Modified Somatic Perception Questionnaire (MSPQ) and the Pain Beliefs Screening Instrument (PBSI) through factorial structural analysis and to investigate the associations of the new scale (if unique) to disability, health condition, and quality of life report in patients with neck and low back pain scheduled for spine fusion surgery., Methods: Factor analysis was used to refine all items within the 2 scales to 4 distinct factors: (1) somatic complaints of the head/neck, (2) somatic complaints of the gastrointestinal symptom, (3) pain beliefs and fear, and (4) self perception of serious problems. Each factor was assessed for concurrent validity with other well-established tools including the Deyo comorbidity index, the Short Form (SF)-36 mental and physical component subscales, and the Oswestry and Neck Disability Indices (ODI/NDI)., Results: The PBSI was fairly to moderately correlated with assessment tools of quality of life (SF-36) and disability assessment (ODI/NDI). Some of the items in the factor 1 from the MSPQ were slightly associated with the Deyo comorbidity index but not with the ODI/NDI., Conclusions: The items from the MSPQ failed to associate with measures of quality of life and disability and thus may provide only marginal value when assessing the multidimensional aspects associated with neck and low back pain. The PBSI has moderate correlation with disability assessments. Neither tool was found to strongly correlate with disability measures or with SF-36 scales (mental and physical component subscales). Additional tools may be needed to further identify the dimensions associated with chronic pain patients., (Copyright © 2011 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.)

Purpose: To investigate differences in pain and disability between patients treated with thrust manipulation (TM) and those treated with non-thrust manipulation (NTM) in a group of patients with mechanical low back pain (LBP) who had a within-session response to an initial assessment and met the clinical prediction rule (CPR). Methods: Data from 71 patients who met the CPR were extracted from a database of patients in a larger randomized controlled trial comparing TM and NTM. Treatment of the first two visits involved either TM or NTM (depending on allocation) and a standardized home exercise programme. Data analysis included descriptive statistics and a two-way ANOVA examining within- and between-groups effects for pain and disability, as well as total visits, total days in care, and rate of recovery. Results: No between-group differences in pain or disability were found for NTM versus TM groups (p=0.55), but within-subjects effects were noted for both groups (p<0.001). Conclusions: This secondary analysis suggests that patients who satisfy the CPR benefit as much from NTM as from TM. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study is to measure the relationship of findings of the Goutallier classification, a qualitative measure of fat content within a designated muscle group, and a dichotomous measure of fatty infiltration (presence or not present) toward delayed or poor recovery after physiotherapy intervention. Methods: The retrospective predictive validity study involved 35 adolescent patients diagnosed with spondylolysis, who received magnetic resonance imaging (MRI) prior to physiotherapy care. Scoring of presence of fatty infiltration and Goutallier classifications from the MRI were compared to success or delayed or poor outcomes with physiotherapy, upon patient discharge from formal care. Results: Although agreement among the physicians who were responsible for scoring was poor, consensus findings of fatty infiltration on both measurement mechanisms were related to delayed or poor physiotherapy outcomes (correlation = 0.28, and the sensitivity of presence of fatty infiltration was 76.2% [95% CI = 61%, 87%], the specificity was 69% [95% CI 44%, 87%], the LR + was 2.5 [95% CI 1.1, 6.8], and the LR- was 0.3 [95% CI 0.1, 0.8] for delayed or poor outcome). Discussion: To our knowledge, this is the first study that has looked at whether fatty infiltration of the multifidus muscle in adolescents was associated with poor or delayed recovery in physiotherapy treatment. Conclusions: The results indirectly support the importance of the multifidus muscles in recovery of low back pain and suggest the significance of future, further research. [ABSTRACT FROM AUTHOR]