Classification-Directed Treatment of Low Back Pain
Condition: Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional
Phase: Phase 1

Summary: 
      The primary purpose of this proposal is to conduct a prospective, randomized, controlled
      clinical trial to examine whether or not treatment based on a person's direction-specific,
      impairment-based LBP classification is more effective than Non-specific treatment in
      improving short- (6 weeks) and long-term (6 and 12 months) outcomes in people with chronic
      LBP. We hypothesize that treatment based on a person's direction-specific, impairment-based
      LBP classification (Classification-specific) will result in better outcomes than Non-specific
      treatment. Our approach to classification-directed treatment is based on the proposal that a
      person's LBP is the result of adopting direction-specific strategies of movement and
      alignment of the spine which then are used repeatedly during the person's everyday
      activities. The exposure of spine tissue to repeated loading in the same direction across a
      day is proposed to accelerate the accumulation of stress, microtrauma, and eventually LBP. We
      also hypothesize that until the factors contributing to the use of the direction-specific
      strategies of the spine are modified, the LBP problem will persist or recur. Identification
      of homogeneous subgroups of people with LBP will enhance 1) the power of clinical trials, 2)
      prognosis, and 3) the ability to identify mechanisms contributing to different LBP problems.
    


Intervention name(s): Classification-directed treatment; Non-specific treatment
Intervention type(s): Behavioral; Behavioral
Intervention description(s): People in the Classification-directed treatment will be treated based on their direction-specific LBP classification. Treatment will consist of 3 primary components. The first component of treatment will be analysis and instruction in modification of the person's direction-specific alignment and movement strategies during symptomatic functional activities and activities in which the person uses similar strategies to those displayed with symptomatic functional activities. The second component is education about the principles of tissue injury and healing and the need to keep active. The third component is exercise prescription that consists of practice in performance of modified versions of the direction-specific impairment tests from the exam, with an emphasis on impairments that can be modified to eliminate symptoms.; People in the Non-specific treatment will be provided treatment that incorporates treatment commonly cited in the literature for people with chronic LBP. The first component of treatment will consist of training in functional activities based on biomechanical principles. The second component will include general education about low back pain. The third component is exercise prescription that is directed at improving the strength and flexibility of the trunk and limbs.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: low back pain; classification; spine