Author Names
Sampath, K. K., Mani, R., Miyamori, T., & Tumility, S.
Reviewer Name
Jada Holmes, 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?
- Cannot Determine, Not Reported, or Not Applicable
- 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
The addition of a prescriptive program of exercises targeting the gluteal musculature and manual therapy targeting the hip joints to a pragmatic low‐back pain intervention led to small to medium improvements in self‐reported disability, pain, GRoC, and patient satisfaction in individuals presenting with a primary complaint of mechanical LBP.
Key Finding #2
Further research should examine long-term effectiveness of the current intervention because the study only examined short‐term outcomes, and the effectiveness of this intervention in the long‐term is unknown.
Please provide your summary of the paper
This study shows implementing hip interventions (strengthening and manual therapy) along with the typical LBP treatment provided to patients helped patients see greater improvements in self-reported disability, pain levels, GRoC, and patient satisfaction in 2-weeks and at discharge. This was the first study to look at how adding hip interventions would impact mechanical LBP, so further research would need to be done to see if the findings of this study are similar. The results also showed that the effects of the intervention strengthened over the course of the administration of therapy.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
Further research should look into the implementation of hip interventions for patients with LBP to see if short-term effects can be substantiated as they were in this study and if long-term effects can be established. For now, I would say that if adding hip interventions to a patient’s treatment that is dealing with LBP is helpful to them, then it would be beneficial to do so. Regardless of what little literature there is about this specific intervention when dealing with LBP, trying things like this on patients has little risk and could generate plenty of reward on a case-to-case basis.
