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Practice guideline-based care may not be useful for all patients with low back pain
Patients with disc degeneration had no significant improvement in outcomes related to type of care.
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A study comparing clinical practice guideline-based care and guideline-discordant treatment for patients with acute lower back pain indicated that the presence and type of spinal pathology may play a role in the outcome of nonoperative care.
“Clinical practice-guideline of care seems to be more effective than guideline-discordant care in patients with no identifiable spinal pathology or patients with spinal stenosis,” Paul Bishop, DC, MD, PhD, said at the 36th Annual Meeting of the International Society of the Study of the Lumbar Spine. “But, guideline-based care seems to be ineffective and equivalent to guideline-discordant care in patients with underlying significant disc degeneration who complained of acute lower back pain.”
Bishop recommended that clinicians should consider developing pathology-specific nonoperative treatment strategies.
Randomized controlled trial
In a randomized controlled clinical trial, Bishop and colleagues studied 50 patients who received nonoperative treatment based exclusively on clinical practice guidelines (the concordant group) and 51 patients who received family physician-directed care (the guideline-discordant group). The study included patients between the ages of 19 and 59 years old who had Quebec Task Force Spinal Disorders I and II and experienced acute low back pain for less than 4 weeks.
The investigators used the difference in Roland Morris Disability scores from baseline to 16 weeks as the primary outcome measure, and used the differences in the SF-36 bodily pain and physical function scores from baseline to 16 weeks as secondary outcome measures.
No pathology
Using either CT or MRI scans, they found that 33 of the studied patients showed no evidence of spinal pathology, 31 patients had Thompson grade III or higher disc degeneration, 27 patients had mild to severe spinal stenosis, and 10 had evidence of facet joint arthropathy. The investigators discovered that patients with no underlying spinal pathology and those with spinal stenosis who received guideline-concordant treatment showed significantly greater improvements in all outcome measures from baseline to 16 weeks compared to those in the discordant group.
For more information:
- A Workplace BC, formerly the Workers’ Compensations Board of British Columbia, grant supported the study.
Reference:
- Bishop P, Fisher C, Quon J, et al. Clinical practice guideline-based treatment is not effective for all patients with acute lower back pain: A randomized controlled clinical trial. Paper #62. Presented at the 36th Annual Meeting of the International Society of the Study of the Lumbar Spine. May 4-8, 2009. Miami.