A structured protocol of evidence-based conservative care compared with usual care for acute nonspecific low back pain: A randomized clinical trial

Parkin-Smith, G.F., Norman, I.J., Briggs, E., Angier, E., Wood, T.G. and Brantingham, J.W. (2012) A structured protocol of evidence-based conservative care compared with usual care for acute nonspecific low back pain: A randomized clinical trial. Archives of Physical Medicine and Rehabilitation, 93 (1). pp. 11-20.

Abstract

Objective: To compare a protocol of evidence-based conservative care with usual care for acute nonspecific low back pain (LBP) of less than 6 weeks' duration.

Design: Parallel-group randomized trial.

Setting: Three practices in the United Kingdom.

Participants: Convenience sample of 149 eligible patients were invited to participate in the study, with 118 volunteers being consented and randomly allocated to a treatment group.

Interventions: The experimental group received evidence-based treatments for acute nonspecific LBP as prescribed in a structured protocol of care developed for this study. The control group received usual conservative care. Participants in both groups could receive up to 7 treatments over a 4-week period.

Main Outcome Measures: Oswestry Low Back Disability Index (ODD, visual analog scale (VAS), and Patient Satisfaction Questionnaire, alongside estimation of clinically meaningful outcomes.

Results: Total dropout rate was 14% (n=16), with 13% of data missing. Missing data were replaced using a multiple imputation method. Participants in both groups received an average of 6 treatments. There was no statistically significant difference in disability ODI scores at the end of week 4 (P=.33), but there was for pain (VAS) scores (P <.001). Interestingly, there were statistically significant differences between the 2 groups for both disability and pain measures at the midpoint of the treatment period (P <.001). Patient satisfaction with care was equally high (85%) in both groups. Minimally clinically important differences in scores and number needed to treat scores (NNT < 6) indicated that the experimental treatment (protocol of care) offered a clinically meaningful benefit over the control treatment (usual care), particularly at the midpoint of the treatment period.

Conclusions: Overall, the 2 treatment groups were similar based on primary or secondary outcome measure scores for the full treatment period (4 weeks, with up to 7 treatments). However, there were statistically significant and clinically meaningful differences in both disability and pain scores at week 2 (midpoint) with 4 treatments, suggesting that the protocol of care had a more rapid effect than usual care.