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Effectiveness of an Extension-Oriented Treatment Approach in a Subgroup of Subjects With Low Back Pain: A Randomized Clinical Trial

DA Browder, MAJ, PT, DPT, OCS, is Director, Outpatient Physical Therapy, Physical Therapy Department, Wilford Hall Medical Center, San Antonio, Tex, and Assistant Professor, US Army–Baylor University Doctoral Program in Physical Therapy, San Antonio, Tex. Institutional address: 59 CSG/59 DTS/SGOYP, 2200 Bergquist Dr, Ste 1, Lackland AFB, TX 78154 (USA).
JD Childs, PT, PhD, MBA, OCS, FAAOMPT, is Assistant Professor and Director of Research, US Army–Baylor University Doctoral Program in Physical Therapy.
JA Cleland, PT, PhD, OCS, FAAOMPT, is Associate Professor, Franklin Pierce University, Concord, NH, and Physical Therapist, Rehabilitation Services, Concord Hospital, Concord, NH.
JM Fritz, PT, PhD, ATC, is Associate Professor, Division of Physical Therapy, University of Utah, and Clinical Outcomes Research Scientist, Intermountain Healthcare, Salt Lake City, Utah.

david.browder{at}lackland.af.mil

Background and Purpose: The purpose of this multicenter randomized clinical trial was to examine the effectiveness of an extension-oriented treatment approach (EOTA) in a subgroup of subjects with low back pain (LBP) who were hypothesized to benefit from the treatment compared with similar subjects who received a lumbar spine strengthening exercise program.

Methods: Subjects with LBP and symptoms distal to the buttocks that centralized with extension movements were included. Forty-eight subjects were randomly assigned to groups that received an EOTA (n=26) or a strengthening exercise program (n=22). Subjects attended 8 physical therapy sessions and completed a home exercise program. Follow-up data were obtained at 1 week, 4 weeks, and 6 months after randomization. Primary outcome measures were disability (modified Oswestry Low Back Pain Disability Questionnaire) and pain (Numeric Pain Rating Scale).

Results: Subjects in the EOTA group experienced greater improvements in disability compared with subjects who received trunk strengthening exercises at 1 week (mean difference between groups from baseline=8.9, 95% confidence interval [CI]=2.0, 15.9), 4 weeks, (mean difference=14.4, 95% CI=4.8, 23.9), and 6 months (mean difference=14.6, 95% CI=4.6, 24.6). The EOTA group demonstrated greater change in pain at the 1-week follow-up only.

Discussion and Conclusion: An EOTA was more effective than trunk strengthening exercise in a subgroup of subjects hypothesized to benefit from this treatment approach. Additional research is needed to explore whether an EOTA may benefit other subgroups of patients.