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Influence of Directional Preference on Two Clinical Dichotomies: Acute Versus Chronic Pain and Axial Low Back Pain Versus Sciatica
Author(s) -
Donelson Ronald,
Long Audrey,
Spratt Kevin,
Fung Tak
Publication year - 2012
Publication title -
pmandr
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.617
H-Index - 66
eISSN - 1934-1563
pISSN - 1934-1482
DOI - 10.1016/j.pmrj.2012.04.013
Subject(s) - medicine , physical therapy , low back pain , sciatica , depression (economics) , chronic pain , physical medicine and rehabilitation , back pain , lumbar , surgery , alternative medicine , pathology , economics , macroeconomics
Objective To determine whether outcomes from treatment determined by subjects' directional preference (ie, reduction in back and/or leg pain, by performing a single direction of repeated end‐range lumbar movement) would vary based on pain duration, location, or neurologic status. Design A secondary analysis of data from a multicenter randomized clinical trial. Setting Eleven physical therapy departments or clinics in 5 countries, with referrals for both acute and chronic low back pain. Subjects Seventy‐one of 80 subjects with acute to chronic low back pain, and with and without radicular leg pain, and with or without mild neurologic deficit, were found at baseline to have a directional preference and were then treated with directional exercises that matched their directional preference. Methods All of the subjects were treated for 2 weeks with directional exercises and compatible posture modifications. Independent variables were pain duration, pain location, and neurologic status. Main Outcome Measurements Primary measures were back and leg pain intensity and function (Roland Morris Disability Questionnare). Secondary measures were activity interference, medication use, depression (Beck Depression Inventory), and a self‐report of improvement. Results The subjects significantly improved their back and leg pain intensity, disability, and all secondary outcome measures, but pain duration, location, and neurologic status classification did not predict treatment responsiveness. Across all pain duration categories, 91%‐100% either improved or resolved completely. There also was significant improvement across all pain location and neurologic status categories, with no significant differences across the outcome variables. Conclusions In subjects found to have a directional preference who then treated themselves with matching directional exercises, neither pain duration nor pain location and neurologic status predicted their uniformly good‐to‐excellent outcomes.