Effects of Individualised Directional Preference Management Versus Advice For Reducible Discogenic Pain: A Pre-Planned Secondary Analysis of A Randomised Controlled Trial
Abstract Background Low back disorders are prevalent and directional preference management is a common treatment with mixed evidence for effectiveness. Objectives To determine the effectiveness of individualised directional preference management plus guideline-based advice versus advice alone in par...
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| Veröffentlicht in: | Manual therapy 2016-09, Vol.25, p.69-80 |
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| creator | Surkitt, Luke D., BPhysio Ford, Jon J., PhD Chan, Alexander YP., BPhysio Richards, Matthew C., BPhysio Slater, Sarah L., PhD Pizzari, Tania, PhD Hahne, Andrew J., PhD |
| description | Abstract Background Low back disorders are prevalent and directional preference management is a common treatment with mixed evidence for effectiveness. Objectives To determine the effectiveness of individualised directional preference management plus guideline-based advice versus advice alone in participants with reducible discogenic pain of 6-week to 6-month duration. Design Pre-planned secondary analysis of a multicentre, parallel group randomised controlled trial. Methods Participants were randomly allocated to receive a 10-week physiotherapy program of 10-sessions of individualised directional preference management plus guideline-based advice (n=40) or 2-sessions of advice alone (n=38). Primary outcomes were back pain, leg pain and activity limitation. Outcomes were taken at baseline and 5, 10, 26, and 52-weeks. Results Between-group differences significantly favoured directional preference management compared with advice for back pain at 5-weeks (1.28; 95% CI 0.34 to 2.23) and 10-weeks (1.45; 95% CI 0.51 to 2.40), and leg pain at 10-weeks (1.21; 95% CI 0.04 to 2.39). These short-term differences were not maintained. There were no significant differences between-groups for activity limitation. Secondary outcomes and responder analyses favoured directional preference management suggesting between-group differences were clinically important. Conclusions In people with reducible discogenic pain, individualised directional preference management plus guideline-based advice resulted in significant and rapid improvement in short-term back and leg pain compared with advice alone. These effects were not maintained at long-term and there were no differences in activity limitation. Individualised directional preference management could be considered for patients with reducible discogenic pain seeking rapid pain relief however further research is indicated. |
| doi_str_mv | 10.1016/j.math.2016.06.002 |
| format | Article |
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Objectives To determine the effectiveness of individualised directional preference management plus guideline-based advice versus advice alone in participants with reducible discogenic pain of 6-week to 6-month duration. Design Pre-planned secondary analysis of a multicentre, parallel group randomised controlled trial. Methods Participants were randomly allocated to receive a 10-week physiotherapy program of 10-sessions of individualised directional preference management plus guideline-based advice (n=40) or 2-sessions of advice alone (n=38). Primary outcomes were back pain, leg pain and activity limitation. Outcomes were taken at baseline and 5, 10, 26, and 52-weeks. Results Between-group differences significantly favoured directional preference management compared with advice for back pain at 5-weeks (1.28; 95% CI 0.34 to 2.23) and 10-weeks (1.45; 95% CI 0.51 to 2.40), and leg pain at 10-weeks (1.21; 95% CI 0.04 to 2.39). These short-term differences were not maintained. There were no significant differences between-groups for activity limitation. Secondary outcomes and responder analyses favoured directional preference management suggesting between-group differences were clinically important. Conclusions In people with reducible discogenic pain, individualised directional preference management plus guideline-based advice resulted in significant and rapid improvement in short-term back and leg pain compared with advice alone. These effects were not maintained at long-term and there were no differences in activity limitation. Individualised directional preference management could be considered for patients with reducible discogenic pain seeking rapid pain relief however further research is indicated.</description><identifier>ISSN: 1356-689X</identifier><identifier>EISSN: 1532-2769</identifier><identifier>DOI: 10.1016/j.math.2016.06.002</identifier><identifier>PMID: 27422600</identifier><language>eng</language><publisher>Scotland: Elsevier Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Directional preference ; Female ; Humans ; Low back pain ; Low Back Pain - rehabilitation ; Lumbar intervertebral disc ; Male ; Manipulation, Spinal - standards ; Middle Aged ; Outcome Assessment (Health Care) ; Pain Management - methods ; Patient-Centered Care - standards ; Physical Medicine and Rehabilitation ; Physical Therapy Modalities - standards ; Practice Guidelines as Topic ; Randomised controlled trial ; Time Factors</subject><ispartof>Manual therapy, 2016-09, Vol.25, p.69-80</ispartof><rights>Elsevier Ltd</rights><rights>2016 Elsevier Ltd</rights><rights>Copyright © 2016 Elsevier Ltd. All rights reserved.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c444t-edb2c70a2c99597b069d797cbe2d87c80169dbf5e2a211b68799d59fe78b85923</citedby><cites>FETCH-LOGICAL-c444t-edb2c70a2c99597b069d797cbe2d87c80169dbf5e2a211b68799d59fe78b85923</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.math.2016.06.002$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,45974</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27422600$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Surkitt, Luke D., BPhysio</creatorcontrib><creatorcontrib>Ford, Jon J., PhD</creatorcontrib><creatorcontrib>Chan, Alexander YP., BPhysio</creatorcontrib><creatorcontrib>Richards, Matthew C., BPhysio</creatorcontrib><creatorcontrib>Slater, Sarah L., PhD</creatorcontrib><creatorcontrib>Pizzari, Tania, PhD</creatorcontrib><creatorcontrib>Hahne, Andrew J., PhD</creatorcontrib><title>Effects of Individualised Directional Preference Management Versus Advice For Reducible Discogenic Pain: A Pre-Planned Secondary Analysis of A Randomised Controlled Trial</title><title>Manual therapy</title><addtitle>Man Ther</addtitle><description>Abstract Background Low back disorders are prevalent and directional preference management is a common treatment with mixed evidence for effectiveness. Objectives To determine the effectiveness of individualised directional preference management plus guideline-based advice versus advice alone in participants with reducible discogenic pain of 6-week to 6-month duration. Design Pre-planned secondary analysis of a multicentre, parallel group randomised controlled trial. Methods Participants were randomly allocated to receive a 10-week physiotherapy program of 10-sessions of individualised directional preference management plus guideline-based advice (n=40) or 2-sessions of advice alone (n=38). Primary outcomes were back pain, leg pain and activity limitation. Outcomes were taken at baseline and 5, 10, 26, and 52-weeks. Results Between-group differences significantly favoured directional preference management compared with advice for back pain at 5-weeks (1.28; 95% CI 0.34 to 2.23) and 10-weeks (1.45; 95% CI 0.51 to 2.40), and leg pain at 10-weeks (1.21; 95% CI 0.04 to 2.39). These short-term differences were not maintained. There were no significant differences between-groups for activity limitation. Secondary outcomes and responder analyses favoured directional preference management suggesting between-group differences were clinically important. Conclusions In people with reducible discogenic pain, individualised directional preference management plus guideline-based advice resulted in significant and rapid improvement in short-term back and leg pain compared with advice alone. These effects were not maintained at long-term and there were no differences in activity limitation. Individualised directional preference management could be considered for patients with reducible discogenic pain seeking rapid pain relief however further research is indicated.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Directional preference</subject><subject>Female</subject><subject>Humans</subject><subject>Low back pain</subject><subject>Low Back Pain - rehabilitation</subject><subject>Lumbar intervertebral disc</subject><subject>Male</subject><subject>Manipulation, Spinal - standards</subject><subject>Middle Aged</subject><subject>Outcome Assessment (Health Care)</subject><subject>Pain Management - methods</subject><subject>Patient-Centered Care - standards</subject><subject>Physical Medicine and Rehabilitation</subject><subject>Physical Therapy Modalities - standards</subject><subject>Practice Guidelines as Topic</subject><subject>Randomised controlled trial</subject><subject>Time Factors</subject><issn>1356-689X</issn><issn>1532-2769</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUsFu1DAQjRCIlsIPcEA-csniOIkdI4S0Ki1UKmLVFsTNcuxJ8eK1i52stL_EVzLZLRw4IKSRPNK8eX5-z0XxvKKLilb81Xqx0eO3BcN-QbEoe1AcV23NSia4fIh93fKSd_LrUfEk5zWlVDa0fVwcMdEwxik9Ln6eDQOYMZM4kItg3dbZSXuXwZJ3LuHExaA9WSUYIEEwQD7qoG9hA2EkXyDlKZOl3TocnMdErsBOxvUecDubeAvBGbLSLrwmy5mkXHkdApJfg4nB6rQjS-TfZbdXsCRXOti42d9_GsOYovfY3iSn_dPi0aB9hmf350nx-fzs5vRDefnp_cXp8rI0TdOMJdieGUE1M1K2UvSUSyukMD0w2wnToVvS9kMLTLOq6nknpLStHEB0fddKVp8ULw-8dyn-mCCPCvUY8Kgc4pRV1dWibtD19j-gtOl4VwmBUHaAmhRzRjvVXXIbNEBVVM1xqrWa41RznIpi0VnKi3v-qd-A_bPyOz8EvDkAAA3ZOkgqGzfHZPfhKRvdv_nf_rVuvMPItP8OO8jrOCVMB9-hMlNUXc8fav5PFa8pZ1zWvwDvncej</recordid><startdate>20160901</startdate><enddate>20160901</enddate><creator>Surkitt, Luke D., BPhysio</creator><creator>Ford, Jon J., PhD</creator><creator>Chan, Alexander YP., BPhysio</creator><creator>Richards, Matthew C., BPhysio</creator><creator>Slater, Sarah L., PhD</creator><creator>Pizzari, Tania, PhD</creator><creator>Hahne, Andrew J., PhD</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7TS</scope></search><sort><creationdate>20160901</creationdate><title>Effects of Individualised Directional Preference Management Versus Advice For Reducible Discogenic Pain: A Pre-Planned Secondary Analysis of A Randomised Controlled Trial</title><author>Surkitt, Luke D., BPhysio ; Ford, Jon J., PhD ; Chan, Alexander YP., BPhysio ; Richards, Matthew C., BPhysio ; Slater, Sarah L., PhD ; Pizzari, Tania, PhD ; Hahne, Andrew J., PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c444t-edb2c70a2c99597b069d797cbe2d87c80169dbf5e2a211b68799d59fe78b85923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Directional preference</topic><topic>Female</topic><topic>Humans</topic><topic>Low back pain</topic><topic>Low Back Pain - rehabilitation</topic><topic>Lumbar intervertebral disc</topic><topic>Male</topic><topic>Manipulation, Spinal - standards</topic><topic>Middle Aged</topic><topic>Outcome Assessment (Health Care)</topic><topic>Pain Management - methods</topic><topic>Patient-Centered Care - standards</topic><topic>Physical Medicine and Rehabilitation</topic><topic>Physical Therapy Modalities - standards</topic><topic>Practice Guidelines as Topic</topic><topic>Randomised controlled trial</topic><topic>Time Factors</topic><toplevel>online_resources</toplevel><creatorcontrib>Surkitt, Luke D., BPhysio</creatorcontrib><creatorcontrib>Ford, Jon J., PhD</creatorcontrib><creatorcontrib>Chan, Alexander YP., BPhysio</creatorcontrib><creatorcontrib>Richards, Matthew C., BPhysio</creatorcontrib><creatorcontrib>Slater, Sarah L., PhD</creatorcontrib><creatorcontrib>Pizzari, Tania, PhD</creatorcontrib><creatorcontrib>Hahne, Andrew J., PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Physical Education Index</collection><jtitle>Manual therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Surkitt, Luke D., BPhysio</au><au>Ford, Jon J., PhD</au><au>Chan, Alexander YP., BPhysio</au><au>Richards, Matthew C., BPhysio</au><au>Slater, Sarah L., PhD</au><au>Pizzari, Tania, PhD</au><au>Hahne, Andrew J., PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of Individualised Directional Preference Management Versus Advice For Reducible Discogenic Pain: A Pre-Planned Secondary Analysis of A Randomised Controlled Trial</atitle><jtitle>Manual therapy</jtitle><addtitle>Man Ther</addtitle><date>2016-09-01</date><risdate>2016</risdate><volume>25</volume><spage>69</spage><epage>80</epage><pages>69-80</pages><issn>1356-689X</issn><eissn>1532-2769</eissn><abstract>Abstract Background Low back disorders are prevalent and directional preference management is a common treatment with mixed evidence for effectiveness. Objectives To determine the effectiveness of individualised directional preference management plus guideline-based advice versus advice alone in participants with reducible discogenic pain of 6-week to 6-month duration. Design Pre-planned secondary analysis of a multicentre, parallel group randomised controlled trial. Methods Participants were randomly allocated to receive a 10-week physiotherapy program of 10-sessions of individualised directional preference management plus guideline-based advice (n=40) or 2-sessions of advice alone (n=38). Primary outcomes were back pain, leg pain and activity limitation. Outcomes were taken at baseline and 5, 10, 26, and 52-weeks. Results Between-group differences significantly favoured directional preference management compared with advice for back pain at 5-weeks (1.28; 95% CI 0.34 to 2.23) and 10-weeks (1.45; 95% CI 0.51 to 2.40), and leg pain at 10-weeks (1.21; 95% CI 0.04 to 2.39). These short-term differences were not maintained. There were no significant differences between-groups for activity limitation. Secondary outcomes and responder analyses favoured directional preference management suggesting between-group differences were clinically important. Conclusions In people with reducible discogenic pain, individualised directional preference management plus guideline-based advice resulted in significant and rapid improvement in short-term back and leg pain compared with advice alone. These effects were not maintained at long-term and there were no differences in activity limitation. Individualised directional preference management could be considered for patients with reducible discogenic pain seeking rapid pain relief however further research is indicated.</abstract><cop>Scotland</cop><pub>Elsevier Ltd</pub><pmid>27422600</pmid><doi>10.1016/j.math.2016.06.002</doi><tpages>12</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Directional preference Female Humans Low back pain Low Back Pain - rehabilitation Lumbar intervertebral disc Male Manipulation, Spinal - standards Middle Aged Outcome Assessment (Health Care) Pain Management - methods Patient-Centered Care - standards Physical Medicine and Rehabilitation Physical Therapy Modalities - standards Practice Guidelines as Topic Randomised controlled trial Time Factors |
| title | Effects of Individualised Directional Preference Management Versus Advice For Reducible Discogenic Pain: A Pre-Planned Secondary Analysis of A Randomised Controlled Trial |
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