Miyamoto GC1,2, Hancock MJ3, van Tulder MW2, Cabral CMN1
1Universidade Cidade de São Paulo, São Paulo, Brazil, 2Vrije Universiteit Amsterdam, Amsterdam, Netherlands, 3Macquarie University, Sydney, Australia
Background: The updated treatment-based classification system was developed to match interventions to specific subgroups of patients with low back pain in order to optimize the effect size. These subgroups include symptom modulation, movement control and functional optimization. However, there is no evidence if Pilates exercises can promote more benefits for a specific subgroup of the updated treatment-based classification system.
Purpose: To investigate whether updated treatment-based classification system can identify patients with non-specific chronic low back pain who benefit more from Pilates-based exercises.
Methods: 222 patients aged 18 to 80 years were randomly allocated to four treatment groups (n=74 per group): booklet group (did not receive additional treatment), Pilates group (received treatment two or three a week). All groups received an educational booklet. The intervention lasted six weeks. Patients were classified into one of the three subgroups of the updated treatment-based classification system: symptom modulation, movement control and functional optimization. We hypothesised that the movement control subgroup would respond best to Pilates intervention because the exercises focus on sensorimotor exercises, stabilization exercises and flexibility exercises that are interventions recommended for patients of this subgroup. Thus, we combined the modulation symptoms and functional optimization in a unique subgroup (movement control subgroup negative) to compare with movement control subgroup positive. The clinical outcomes were pain intensity (Pain Numerical Rating Scale: 0-10) and disability (Roland Morris Disability Questionnaire: 0-24). A subgroup analysis was conducted using linear regression models considering the change in pain and disability from baseline to six weeks after randomization as dependent variables.
Results: None of the interaction terms for pain and disability were statically significant and point estimates did not exceed the threshold determined for clinical importance (1-point for pain intensity, and 3-point disability). Thus, the effect of treatment (Pilates versus Booklet) is similar in the movement control subgroup positive and movement control negative participants.While the confidence intervals for the interactions are somewhat wide, both interaction terms were in the opposite direction to the hypothesis (beta coefficient=-0.3 for pain intensity, and beta coefficient=-2.4) and the limits of the confidence intervals in the direction of the hypotheses were relatively small ( 1.3 for pain and 0.9 for disability) suggesting we did not miss important moderation effects.
Conclusion(s): There is no a subgroup of the treatment-based classification system for non-specific chronic low back pain that benefits more from Pilates.
Implications: These results show that due to the inability to identify clear effect modifiers for Pilates exercises, the choice of exercise approach should be made based on patient preference and clinician expertise.
Keywords: Low back pain, Pilates, Subgroups
Funding acknowledgements: The authors thank the São Paulo Research Foundation (FAPESP) (process number: 2013/26321-8 and 2016/07915-2) for financial support.
Purpose: To investigate whether updated treatment-based classification system can identify patients with non-specific chronic low back pain who benefit more from Pilates-based exercises.
Methods: 222 patients aged 18 to 80 years were randomly allocated to four treatment groups (n=74 per group): booklet group (did not receive additional treatment), Pilates group (received treatment two or three a week). All groups received an educational booklet. The intervention lasted six weeks. Patients were classified into one of the three subgroups of the updated treatment-based classification system: symptom modulation, movement control and functional optimization. We hypothesised that the movement control subgroup would respond best to Pilates intervention because the exercises focus on sensorimotor exercises, stabilization exercises and flexibility exercises that are interventions recommended for patients of this subgroup. Thus, we combined the modulation symptoms and functional optimization in a unique subgroup (movement control subgroup negative) to compare with movement control subgroup positive. The clinical outcomes were pain intensity (Pain Numerical Rating Scale: 0-10) and disability (Roland Morris Disability Questionnaire: 0-24). A subgroup analysis was conducted using linear regression models considering the change in pain and disability from baseline to six weeks after randomization as dependent variables.
Results: None of the interaction terms for pain and disability were statically significant and point estimates did not exceed the threshold determined for clinical importance (1-point for pain intensity, and 3-point disability). Thus, the effect of treatment (Pilates versus Booklet) is similar in the movement control subgroup positive and movement control negative participants.While the confidence intervals for the interactions are somewhat wide, both interaction terms were in the opposite direction to the hypothesis (beta coefficient=-0.3 for pain intensity, and beta coefficient=-2.4) and the limits of the confidence intervals in the direction of the hypotheses were relatively small ( 1.3 for pain and 0.9 for disability) suggesting we did not miss important moderation effects.
Conclusion(s): There is no a subgroup of the treatment-based classification system for non-specific chronic low back pain that benefits more from Pilates.
Implications: These results show that due to the inability to identify clear effect modifiers for Pilates exercises, the choice of exercise approach should be made based on patient preference and clinician expertise.
Keywords: Low back pain, Pilates, Subgroups
Funding acknowledgements: The authors thank the São Paulo Research Foundation (FAPESP) (process number: 2013/26321-8 and 2016/07915-2) for financial support.
Topic: Musculoskeletal: spine
Ethics approval required: Yes
Institution: Universidade Cidade de São Paulo
Ethics committee: Research Ethics Committee of Universidade Cidade de São Paulo
Ethics number: CAAE: 29303014.7.0000.0064
All authors, affiliations and abstracts have been published as submitted.
