Author Names
Bade, M., Cobo-Esteves, M., Neeley, D., Pandya, J., Gunderson, T., Cook, C.
Reviewer Name
Mallory Martlock, SPT
Reviewer Affiliations
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Rationale- The benefits of providing manual therapy and exercise targeting the hips in individuals with mechanical low-back pain (LBP) are not well established. Objectives- The objective in this study is to determine whether a formal prescriptive treatment protocol for the hips improves outcomes in patients with a primary complaint of mechanical LBP. Methods- Eighty-four (84) subjects (50 males, 46.1 ± 16.2 years) were randomized to 1 of 2 groups: pragmatic treatment of the lumbar spine only (LBP) (n = 39) or pragmatic treatment of the lumbar spine and prescriptive treatment of bilateral hips (LBP + HIP) (n = 45). Pragmatic treatment of the lumbar spine was based upon published clinical guidelines. Prescriptive treatment of the hips involved the use of 3 hip exercises targeting the gluteal musculature and 3 mobilization techniques targeting the hips. Subjects were assessed at baseline, 2 weeks, and at discharge with the following measures: Modified Oswestry Disability Index, Numeric Pain Rating Scale, a global rating of change (GRoC) score, the patient acceptable symptom state (PASS), and patient satisfaction. Results- At 2 weeks, significant differences between groups differences were found in GRoC and patient satisfaction (P < .05) favoring the LBP + HIP group. At discharge, there were significant differences on the Modified Oswestry Disability Index, numeric pain rating scale, GRoC, and patient satisfaction favoring the LBP + HIP group (P < .05). Effect sizes were small to medium. Conclusion- Our findings suggest that a prescriptive treatment of the hips may be of clinical value to individuals presenting with the primary complaint of mechanical LBP
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- No
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- No
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Yes
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
Hip interventions and mobilizations in addition to normal treatment of mechanical LBP appeared to be more effective that treatment of LBP alone.
Key Finding #2
This study was unique to other studies that have investigated the effect of hip interventions in addition to LBP treatment by including hip manipulation and mobilization techniques.
Key Finding #3
Statistically significant differences were found in favor for the LBP + Hip group at discharge for the ODI, NPRS, GRoC and patient satisfaction.
Please provide your summary of the paper
This study investigated the effect of hip interventions and mobilizations on patients with mechanical LBP. Patients were randomly assigned to two groups, one which intervened with only LBP treatment, and the other group which intervened with mechanical LBP treatment plus hip interventions and mobilizations. Significant differences were found by discharge in favor of the LBP + Hip treatment protocol. A small to medium effect size was found in the group that had the additive hip protocol in their treatment. Since the therapists were responsible for collecting the data, it was impossible to carry out a double blinded study, which could contribute to some bias in the results. Overall, the addition of hip interventions and mobilizations was shown to provide some additional relief in LBP patients compared to low-back interventions alone.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This paper showed support of hip interventions and mobilizations for patients with low back pain through improved scores in self reported disability and pain, as well as improved patient satisfaction. While the effect sizes were small, and the experimental set up was prone to some bias, these results can impact clinical practice by providing therapists with some additional treatment options for their patients struggling with low back pain. The prevalence and chronicity of this condition can be frustrating for both the patient and the therapist, so it is valuable to consider any treatment option that could provide the patient relief, including treatment to the joints above and below the area of concern.
