Abstract
Objective
This study presents the outcomes of patients with lumbar radiculopathy secondary to
disk herniation treated after a diagnosis-based clinical decision rule.
Methods
A prospective observational cohort study was conducted at a multidisciplinary, integrated
clinic that includes chiropractic and physical therapy health care services. Data
on 49 consecutive patients were collected at baseline, at the end of conservative,
nonsurgical treatment and a mean of 14.5 months after cessation of treatment. Disability
was measured using the Bournemouth Disability Questionnaire (BDQ) and pain using the
Numerical Rating Scale for pain. Fear beliefs were measured with the Fear-Avoidance
Beliefs Questionnaire (FABQ). Patients also self-rated improvement.
Results
Mean duration of complaint was 60.5 weeks. Mean self-rated improvement at the end
of treatment was 77.5%. Improvement was described as “good” or “excellent” in nearly
90% of patients. Mean percentage improvement on the BDQ was 60.4%. Numerical Rating
Scale improved 4.1 points and FABQ improved 4.8 points. Clinically meaningful improvements
in pain and disability were seen in 79% and 70% of patients, respectively. Mean number
of visits was 13.2. After an average long-term follow-up of 14.5 months, mean self-rated
improvement was 81.1%. “Good” or “excellent” improvement was reported by 80% of patients.
Mean percentage improvement in BDQ was 67.4%. Numerical Rating Scale improved 4.2
points and FABQ 4.5 points. Clinically meaningful improvements in pain and disability
were seen in 79% and 73% of patients, respectively.
Conclusions
Management based on the decision rule yielded favorable outcomes in this cohort study.
Improvement appeared to be maintained over the long term.
Key Indexing Terms
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Manipulative & Physiological TherapeuticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology of low back syndromes.in: Morris CE Low back syndromes: integrated clinical management. McGraw-Hill, New York2006: 83-118
- Back pain and sciatica.N Engl J Med. 1988; 318: 291-300
- Lumbar disc herniations: a review of surgical and non-surgical indications and outcomes.J Back Musculoskel Rehabil. 2000; 14: 79-88
- The intervertebral disc and its syndromes.in: Morris CE Low back syndromes: integrated clinical management. McGraw-Hill, New York2006: 149-184
- A theoretical model for the development of a diagnosis-based clinical decision rule for the management of patients with spinal pain.BMC Musculoskelet Disord. 2007; 8: 75
- A diagnosis-based clinical decision rule for patients with spinal pain. Part 2: Review of the literature.Chiropr Osteopath. 2008; 16: 8
- A nonsurgical approach to the management of patients with cervical radiculopathy: a prospective observational cohort study.J Manipulative Physiol Ther. 2006; 29: 279-287
- A non-surgical approach to the management of lumbar spinal stenosis: a prospective observational cohort study.BMC Musculoskelet Disord. 2006; 7: 16
- Outcome of pregnancy related lumbopelvic pain treated according to a diagnosis-based clinical decision rule: a prospective observational cohort study.J Manipulative Physiol Ther. 2009; ([in press]): 32
- Return to work after two years of total disability: a case report.J Occup Rehab. 2006; 16: 253-260
- Clinical neurodynamics. A new system of musculoskeletal treatment.Elsevier, Edinburgh2005
- Neurologic examination.in: Haldeman S 3rd ed. Principles and practice of chiropractic. McGraw-Hill, New York2005: 537-560
- Chiropractic management of low back pain and low back–related leg complaints: a literature synthesis.J Manipulative Physiol Ther. 2008; 31: 659-674
- Intervertebral disc pressure changes during low back treatment procedures.in: BED—Advances in Bioengineering. 1998: 39
- Intervertebral disc pressure changes during a chiropractic procedure.in: BED—Advances in Bioengineering. 36. 1997: 215-216
- A randomized clinical trail and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain.Eur Spine. 2005; 15: 1070-1082
- The sensitive nervous system.Noigroup Publications, Adelaide, Australia2000
- The lumbar spine: mechanical diagnosis and therapy.2nd ed. Spinal Publications, Waikenae, NZ2003
- Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests.Man Ther. 2005; 10: 207-218
- Clinical predictors of screening lumbar zygapophyseal joint blocks: development of clinical prediction rules.Spine J. 2006; 6: 370-379
- A series of consecutive cases of low back pain with radiating leg pain treated by chiropractors.J Manipulative Physiol Ther. 1995; 18: 335-342
- Muscle energy techniques.2nd ed. Edinburgh, Churchill Livingstone2001
- Myofascial pain and dysfunction: the trigger point manual. Volume 1.Williams and Wilkens, Baltimore1999
- Lumbopelvic sensorimotor training and functional stabilization.in: Morris CE Low back syndromes: integrated clinical management. McGraw-Hill, New York2006: 741-780
- Graded activity for low back pain in occupational health care.Ann Int Med. 2004; 140: 77-84
- High fear-avoiders of physical activity benefit from an exercise program for patients with back pain.Spine. 2004; 29: 1167-1172
- The Bournemouth Questionnaire. A short-form comprehensive outcome measure. I. Psychometric properties in back pain patients.J Manipulative Physiol Ther. 1999; 22: 503-510
- Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale.Pain. 2001; 94: 149-158
- Assessing the clinical significance of change scores recorded on subjective outcome measures.J Manipulative Physiol Ther. 2004; 27: 26-35
- A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability.Pain. 1993; 52: 157-168
- Consistency of history taking and physical examination in patients with suspected lumbar nerve root involvement.Spine. 2000; 25: 91-97
- Reliability of the lumbar flexion, lumbar extension, and passive straight leg raise test in normal populations embedded within a complete physical examination.Spine. 2001; 26: 2714-2718
- Reproducibility of physical signs in low-back pain.Spine. 1989; 14: 908-918
- What diagnostic tests are useful for low back pain?.Best Pract Res Clin Rheumatol. 2005; 19: 557-575
- A systematic review of the passive straight leg raising test as a diagnostic aid for low back pain (1989 to 2000).Spine. 2002; 27: E388-E395
- Radiographically determined anatomical location of point of peak pressure during pisiform and hypothenar contact manipulation procedures.in: Proceedings of the International Conference on Spinal Manipulation Oct 5-6. Foundation for Chiropractic Education and Research, Toronto2002: 20
- Correlation of clinical examination characteristics with three sources of chronic low back pain.Spine J. 2003; 3: 460-465
- Diagnosing painful sacroiliac joints: a validity study of a McKenzie evaluation and sacroiliac provocation tests.Aus J Physiother. 2003; 49: 89-97
- Therapeutic exercise for spinal segmental stabilization in low back pain. Scientific basis and clinical approach.Churchill Livingstone, Edinburgh1999
- Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial.JAMA. 2006; 296: 2441-2450
- Epidural steroid injection for nerve root compression has short term but no long term effect: a randomised controlled trial.Spine J. 2004; 4: 20S
- The use of lumbar extension in the evaluation and treatment of patients with acute herniated nucleus pulposus. A preliminary report.Clin Orthop Relat Res. 1986; : 211-218
- Nonoperative management of herniated nucleus pulposus patient selection by the extension sign.Orthop Rev. 1992; 21: 181-188
- Centralization phenomenon as a prognostic factor for chronic low back pain and disability.Spine. 2001; 26: 758-764
- Centralization: association between repeated end-range pain responses and behavioral signs in patients with acute non-specific low back pain.J Rehabil Med. 2005; 37: 286-290
- A descriptive study of the centralization phenomenon a prospective analysis.Spine. 1999; 24: 676-683
- Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation.Eur Spine J. 2000; 9: 202-207
- Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations.Spine J. 2006; 6: 131-137
- Interexaminer reliability of the hip extension test for suspected impaired motor control of the lumbar spine.J Manipulative Physiol Ther. 2006; 29: 374-377
- Interrater reliability of clinical examination measures for identification of lumbar segmental instability.Arch Phys Med Rehabil. 2003; 84: 1858-1864
- Reliability and validity of the active straight leg raise test in posterior pelvic pain since pregnancy.Spine. 2001; 26: 1167-1171
- Low back disorders. Evidence-based prevention and rehabilitation.Human Kinetics, Champaign, IL2002
- Segmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials.Clin Rehab. 2006; 20: 553-567
- Lumbar stabilizing exercises improve activities of daily living in patients with lumbar disc herniation.J Back Musculoskel Rehab. 2005; 18: 55-60
- The effects of a graded activity intervention for low back pain in occupational health on sick leave, functional status and pain: 12-month results of a randomized controlled trial.J Occup Rehabil. 2005; 15: 569-580
- The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant-conditioning behavioral approach.Phys Ther. 1992; 72 ([discussion 91-3]): 279-290
- Physiology of chronic spinal pain syndromes from animal models to biomechanics.Spine. 2002; 27: 2526-2537
- Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain.J Pain. 2006; 7: 261-271
- Physical conditioning programs for workers with back and neck pain a Cochrane systematic review.Spine. 2003; 28: E391-E395
- Multidisciplinary group rehabilitation versus individual physiotherapy for chronic nonspecific low back pain: a randomized trial.Spine. 2006; 31: 371-376
- Individually tailored treatment targeting activity, motor behavior, and cognition reduces pain-related disability: a randomized controlled trial in patients with musculoskeletal pain.J Pain. 2005; 6: 588-603
- Frequency and characteristics of side effects of spinal manipulative therapy.Spine. 1997; 22: 435-441
- Adverse reactions to chiropractic treatment and their effects on satisfaction and clinical outcomes among patients enrolled in the UCLA neck pain study.J Manipulative Physiol Ther. 2004; 27: 16-25
- Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study.Spine. 2005; 30: 1477-1484
- A critical guide to case series reports.Spine. 2003; 28: 1631-1634
Article info
Publication history
Accepted:
July 27,
2009
Received in revised form:
July 15,
2009
Received:
April 18,
2009
Identification
Copyright
© 2009 Published by Elsevier Inc.
