Low Back Pain – Evidence-based Medicine and Current Clinical Practice. Is there Any Reason to Change Anything?

Česká verze

Authors: E. Nováková; M. Říha
Authors place of work: Oddělení rehabilitační a fyzikální medicíny, ÚVN – VFN Praha
Published in the journal: Cesk Slov Neurol N 2017; 80/113(3): 280-284
Category: Přehledný referát
doi: https://doi.org/10.14735/amcsnn2017280

Summary

The aim of this paper is to outline current options of LBP care, including a summary of an extensive personal clinical experience using the Mechanical Diagnosis and Therapy (MDT, formerly known as the McKenzie method). Results from a so far only randomised controlled trial of LBP care in the Czech Republic are included. LBP is one of the most frequent causes of visits to a physician of any speciality. Current terminology generally corresponds to the present diagnostic approaches that are based on morphology. Consequently, therapy is non-specific. This paper provides an overview of current research evidence and LBP classification and sub-classification guidelines that suggest functional classification of vertebropathies to enable targeted therapy, for example MDT (an assessment of the symptomatic and mechanical presentation during loaded strategies, followed by treatment according to directional preference). Each syndrome is completed with a typical history and physical presentation. Just as a physician can differentiate flu from tonsillitis, a practitioner employing the MDT concept can utilize clear algorithms to differentiate between mechanical and other syndromes. The McKenzie MDT method is based on an assessment of a symptomatic presentation focussing on specific movements and positions. According to the responses, it is then possible to establish Directional Preference for each individual. The Directional Preference describes a clinical phenomenon where a specific direction of repeated movement and/or sustained position results in a clinically relevant improvement in either symptoms and/or mechanics. Centralisation describes a phenomenon, where distal pain originating from the spine is progressively abolished in the distal to proximal direction. It occurs in response to loading strategies (repeated movements or postures). It is usually a rapid and always a lasting change in pain location, ranging from minutes to days.

Key words:
low back pain – Mechanical Diagnosis and Therapy – directional preference – centralisation – disc herniation – classification algorithm

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Zdroje

1. Deyo RA, Dworkin SF, Amtmann D, et al. Report of the NIH Task Force on Research Standards for Chronic Low Back Pain. Int J Ther Massage Bodywork 2015;8(3):16– 33. doi: 10.2522/ ptj.2015.95.2.e1.

2. Müller I, Kacerovský P. Doporučené postupy pro praktické lékaře: Bolesti zad vertebrogenního původu. Česká lékařská společnost Jana Evangelisty Purkyně 2001. [cit. 2016 Čer 28]. Dostupné z URL: http:/ / www.cls.cz/ seznam-doporucenych-postupu.

3. Cook Ch. Immediate effects from manual therapy: much ado about nothing? J Man Manip Ther 2011;19(1):3– 4. doi: 10.1179/ 106698110X12804993427009.

4. Donelson R. Rapidly reversible low back pain. An evidence-based pathway to widespread recoveries and savings. Hanover: SeflCare First LLC 2007.

5. Rosen MR. Report of a CSAG Committee on Back Pain. Clinical Standards Advisory Group: Back Pain. London HMSO 1994.

6. Spitzer WO. Magnitude of the problem. In: Scientific approach to the assessment and management of activity-related spinal disorders. A monograph for clinicians. Spine (Phila Pa 1976) 1987;12(Suppl 7):12– 5.

7. McKenzie R. The Lumbar Spine: Mechanical Diagnosis and Therapy. 1st ed. Vol. 1– 2. New Zealand: Spinal Publications 2003.

8. Surkitt LD, Ford JJ, Hahne AJ, et al. Efficacy of directional preference management for low back pain: a systematic review. Physical Therapy 2012;92:652– 65. doi: 10.2522/ ptj.20100251.

9. Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back. Spine (Phila Pa 1976) 2004;29(23):2593– 602.

10. Hefford C. McKenzie classification of mechanical spinal pain: profile of syndromes and directions of preference. Manual Therapy 2008;13(1):75– 81.

11. Werneke M, May S. The centralization phenomenon and fear avoidance beliefs as prognostic factors for acute low back pain. J Orthop Sports Phys Ther 2005;35:844– 5.

12. Werneke M, Hart D, Cutrone G, et al. Association Between Directional Preference and Centralization in Patients with Low Back Pain. J Orthop Sports Phys Ther 2011;41(1):22– 31.

13. May S, Aina A. Centralization and directional preference: a systematic review. Man Ther 2012;17(6):497– 506. doi: 10.1016/ j.math.2012.05.003.

14. Edmond S, Cutrone G, Werneke M, et al. Association between centralization and directional preference and functional and pain outcomes in patients with neck pain. J Orthop Sports Phys Ther 2014;44(2):68– 75. doi: 10.2519/ jospt.2014.4632.

15. May S, Littlewood C, Bishop A. Reliability of procedures used in the physical examination of non-specific low back pain: a systematic review. Aust J Physiother 2006;52(2):91– 102.

16. Apeldoorn AT, Bosselaar H, Ostelo RW, et al. Identification of patients with chronic low back pain who might benefit from additional psychological assess-ment. Clin J Pain 2012;28(1):23– 31. doi: 10.1097/ AJP.0b013e31822019d0.

17. Van Helvoirt H, Apeldoorn A, Ostelo R, et al. Transforaminal epidural steroid injections followed by mechanical diagnosis and therapy to prevent surgery for lumbar disc herniations. Pain Med 2014;15(7):1100– 8. doi: 10.1111/ pme.12450.

18. Razmjou H, Kramer JF, Yamada R. Inter-tester reliability of McKenzie evaluation in assessment patients with mechanical LBP. J Orthop Sports Phys Ther 2000;30(7):368– 89.

19. Kilpikoski S, Airaksinen O, Kankaanpaa M, et al. Interexaminer reliability in LBP assessment using the McKenzie method. Spine 2002;27(8):E207– 14.

20. Kilpikoski S. Does centralizing pain on the initial visit predict outcomes in adults with low back pain. A secondary analysis of a randomized controlled trial with 1-year follow-up. Manuelle Therapie 2010;14:136– 41.

21. May S, Ross J. The McKenzie classification system in the extremities: a reliability study using McKenzie assessment forms and experienced clinicians. J Manipulative Physiol Ther 2009;32(7):556– 63. doi: 10.1016/ j.jmpt.2009.08.007.

22. Clare HA, Adams R, Maher CG. Reliability of McKenzie classification of patients with cervical or lumbar pain. J Manipulative Physiol Ther 2005;28(2):122– 7.

23. Abady AH, Rosedale R, Overend TJ, et al. Inter-examiner reliability of diplomats in the mechanical diagnosis and therapy system in assessing patients with shoulder pain. J Man Manip Ther 2014;22(4):199– 205. doi: 10.1179/ 2042618614Y.0000000068.

24. Nováková E. Metoda McKenzie a její použití u pacientů s vertebrogenním syndromem bederním převážně se symptomy iritačně zánikovými. Rehabil Fyz Lék 2000;7:123– 9.

25. Novakova E, May S, Riha M, et al. Direction Spe-cific or Stabilisation Exercises for Chronic Low BackPain Patients. Random Study. MDT World Press 2012;1:1– 7.

26. Hicks GE, Fritz JM, Delitto A, et al. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil 2005;86(9):1753– 62.

27. Pengel M, Refshauge KM, Maher C. Responsiveness of pain disability and physical impairment outcomes in patients with low back pain. Spine 2004;29:879– 83.

28. Stratford P, Binkley J, Solomon P, et al. Assessing change over time in patients with low back pain. Phys Ther 1994;74(6):528– 33.

29. Stratford P, Gill C, Westaway M, et al. Assessing disability and change on individual patients: a report of a patient specific measure. Physiotherapy Canada 1995;47:258– 63.

30. Dreisinger T, Novakova E, Clare H, et al. Clinical outcomes in the MDT setting: a cloud based International multicentre pilot. Vert Mooney Research Foundation, San Diego, California, unpublished data; prezentováno na McKenzie USA a Kanady konferenci, Miami, 2016.

31. McKenzie R, May S. The Cervical and Thoracic Spine-Mechanical Diagnosis and Therapy. 2nd ed. New Zealand: Spinal Publications 2006.

32. McKenzie R, May S. The Extremity-Mechanical Diagnosis and Therapy. 1st ed. New Zealand: Spinal Publications 2002.

33. Nijs J, Apeldoorn A, Hallegraeff H, et al. Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain. Pain Physician 2015;18(3):E333– 46.

34. Fritz JM, Delitto A, Erhard RE, et al. Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial. Spine 2003;28(13):1363– 71.

35. Smart KM, Blake C, Staines A, et al. Clinical indicators of ‘nociceptive’, ‘peripheral neuropathic’ and ‘central’ mechanisms of musculoskeletal pain. A Delphi survey of expert clinicians. Man Ther 2010;15(1):80– 7. doi: 10.1016/ j.math.2009.07.005.

36. Nicholas MK, Linton SJ, Watson PJ, et al. Early identification and management of psychological risk factors (“yellow flags”) in patients with low back pain: a reappraisal. Physical Therapy 2011;91(5):737– 53. doi: 10.2522/ ptj.20100224.

37. Rubinstein S, Pool J, van Tulder M, et al. A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J 2007;16(3):307– 19.

38. Rubinstein S, Middelkoop M, Assendelft W, et al. Spinal manipulative therapy for chronic low-back pain. Spine 2011;36(13):E825– 46. doi: 10.1097/ BRS.0b013e3182197fe1.

39. Rubinstein SM, Terwee CB, Assendelft WJ, et al. Spinal manipulative therapy for acute low-back pain; an update of the Cochrane review. Spine 2013;38(3):E158– 77. doi: 10.1097/ BRS.0b013e31827dd89d.

40. Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Phys Ther 2005;85(3):209– 25.

41. Rackwitz B, de Bie R, Limm H, et al. Segmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials. Clin Reahbil 2006;20(7):553– 67.

42. Macedo LG, Latimer J, Maher CG, et al. Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther 2012;92(3):363– 77. doi: 10.2522/ ptj.20110290.

43. Henry SM, Van Dillen L, Oullette-Morton RH, et al. Outcomes are not different for patient-matched versus nonmatched treatment in subjects with chronic recurrent low back pain: a randomized clinical trial. Spine J 2014;14(12):2799– 810. doi: 10.1016/ j.spinee.2014.03.024.

44. O’Sullivan P. It’s time for change with the management of non-specific chronic low back pain. Br J Sports Med 2012;46(4):224– 7. doi: 10.1136/ bjsm.2010.081638.

45. Smith EB, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskeletal Disorders 2014;15:416. doi: 10.1186/ 1471-2474-15-416.