Individualised functional restoration plus guideline-based advice vs advice alone for non-reducible discogenic low back pain: a randomised controlled trial

Objectives To evaluate the effectiveness of individualised functional restoration plus guideline-based advice compared to advice alone in people with non-reducible discogenic pain (NRDP). Design Subgroup analysis within a multicentre, parallel group randomised controlled trial. Setting Fifteen primary care physiotherapy clinics. Participants Ninety-six participants with clinical features indicative of NRDP (6 week to 6 month duration of injury). Interventions Over a 10 week period physiotherapists provided 10 sessions of individualised functional restoration plus guideline-based advice or two sessions of advice alone. Main outcome measures Primary outcomes were back and leg pain (separate numerical rating scales) and activity limitation (Oswestry Disability Index). Results Between-group differences favoured individualised functional restoration over advice for back pain (1.1, 95% CI 0.1 to 2.1), leg pain (1.5, 95% CI 0.4 to 2.6) and Oswestry (6.3, 95% CI 1:3 to 11.4) at 10 weeks as well as Oswestry at 26 weeks (6.6, 95% CI 1.4 to 11.8). Secondary outcomes and responder analyses also favoured physiotherapy functional restoration suggesting the differences were clinically important. Conclusions In people with NRDP of >= 6 weeks and <= 6 months duration, individualised functional restoration was more effective than advice for all primary outcomes at 10 weeks and sustained at 26 weeks for activity limitation. Our results suggest that for people with NRDP not recovering after 6 weeks, an individualised physiotherapy functional restoration program should be considered. (C) 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.