Evidence synthesis showed limited evidence supporting poor baseline transversus abdominis contraction thickness ratio as a treatment effect modifier favoring motor control exercise .
Limited evidence supported that high baseline transversus abdominis lateral slide was associated with higher pain intensity after various exercise interventions at 1-year follow-up .
However , there was limited evidence for the absence of relation between the contraction thickness ratio of transversus abdominis or anticipatory onset of lateral abdominal muscles at baseline and the short- or long-term LBP intensity after exercise interventions .
There was conflicting evidence for a relation between baseline percent thickness change of lumbar multifidus during contraction and the clinical outcomes of patients after various conservative treatments .
Although individual reports suggest that baseline morphometry or activity of transversus abdominis or lumbar multifidus predict clinical outcome of low back pain ( LBP ) , a related systematic review is unavailable .
Therefore , this review summarized evidence regarding the predictive value of these muscular characteristics .
Critical Appraisal of Clinical Prediction Rules That Aim to Optimize Treatment Selection for Musculoskeletal Conditions
Background Clinical prediction rules ( CPRs ) for treatment selection in musculoskeletal conditions have become increasingly popular . Purpose The purpose s of this review are : ( 1 ) to critically appraise studies evaluating CPRs and ( 2 ) to consider the clinical utility and stage of development of each CPR . Data Sources Pertinent data bases were search ed up to April 2009 . Studies aim ing to develop or evaluate a CPR for treatment response in musculoskeletal conditions were included . Two independent review ers assessed eligibility and extracted method ological data , stage of development , and effect size information . Study Selection / Data Extraction and Synthesis Eighteen studies , evaluating 15 separate CPRs , were included . Fourteen CPRs were at the derivation stage , and all CPRs had been evaluated using a single-arm trial design , thus it is not possible to determine whether the CPRs identify prognosis ( regardless of treatment ) or specifically response to treatment . The CPR at the validation stage investigated spinal manipulative therapy ( SMT ) for low back pain and had been evaluated in 2 separate well-conducted r and omized controlled trials . The first trial demonstrated a clinical ly meaningful effect of the SMT CPR ; the additional effect from SMT in patients “ positive-on-the-rule ” was 15 Oswestry disability units at week 1 and 9 units at week 4 . The second trial showed that the CPR did not generalize to a different clinical setting , including a modified treatment . Limitations Due to differences in methods of reporting and journal publication restraints ( eg , word count restrictions ) , some quality assessment items may have been completed in the included studies , but not captured in this review . Conclusions There is , at present , little evidence that CPRs can be used to predict effects of treatment for musculoskeletal conditions . The principal problem is that most studies use design s that can not differentiate between predictors of response to treatment and general predictors of outcome . Only 1 CPR has been evaluated within an RCT design ed to predict response to treatment . Validation of these rules is imperative to allow clinical application
Evidence synthesis showed limited evidence supporting poor baseline transversus abdominis contraction thickness ratio as a treatment effect modifier favoring motor control exercise .
Limited evidence supported that high baseline transversus abdominis lateral slide was associated with higher pain intensity after various exercise interventions at 1-year follow-up .
However , there was limited evidence for the absence of relation between the contraction thickness ratio of transversus abdominis or anticipatory onset of lateral abdominal muscles at baseline and the short- or long-term LBP intensity after exercise interventions .
There was conflicting evidence for a relation between baseline percent thickness change of lumbar multifidus during contraction and the clinical outcomes of patients after various conservative treatments .
Although individual reports suggest that baseline morphometry or activity of transversus abdominis or lumbar multifidus predict clinical outcome of low back pain ( LBP ) , a related systematic review is unavailable .
Therefore , this review summarized evidence regarding the predictive value of these muscular characteristics .