Pilates Research on Low Back Pain
Derivation of a Clinical Prediction Rule for Identifying a Sub-group of Patients with Low Back Pain Likely to Benefit from Pilates-Based Exercise
Lise R. Stolze, MPT, DSc. Doctoral student (at time of study), Graduate Program in Orthodpedics, Rocky Mountain University of Health Profession, Provo, UT; Physical Therapist, Steadman Hawkins Clinic Denver, Greenwood Village, CO; Affiliate Faculty Member, Regis University, Denver, CO.
Stephen C. Allison, PT, PhD. Professor, Rocky Mountain University of Health Professions, Provo, UT, Associate Professor, Baylor University, Waco, TX
John D. Childs PT, PhD, MBA. Director of Musculoskeletal Research, Department of Physical Therapy (MSGS/SGCUY), 81st Medical Group, Keesler Air Force Base, Biloxi, MS.
Study Design: Prospective cohort study of subjects with non-specific low back pain (LBP)
Objective: The purpose of this study was to derive a preliminary clinical prediction rule for identifying a sub-group of patients with LBP likely to benefit from Pilates exercise therapy.
Background: Pilates has been shown to be effective for patients with LBP, however no work has previously been done to characterize patient attributes for those most likely to have a successful outcome from treatment.
Methods: Treatment response was categorized based on changes in the Oswestry Disability Questionnaire Scores (ODQ) after 8 weeks.An improvement of 50% or greater was categorized as achieving a successful outcome. Thirty seven variables measured at baseline were analyzed with univariate and multivariate methods to derive a clinical prediction rule for successful outcome with Pilates exercise. Accuracy statistics, ROC curves and regression analyses were used to determine the association between standardized examination variables and treatment response status.
Results: 96 subjects participated; 95 completed the study. 51 subjects (53.7%) achieved a successful outcome. A preliminary clinical prediction rule with 5 variables was identified: total trunk flexion ROM < 70 degrees, duration of current symptoms < 6 months, no leg symptoms in the last week, BMI > 25, and left or right hip average rotation > 25 degrees. If any 3 of the 5 attributes were present (positive likelihood ratio 10.64), the probability of experiencing a successful outcome increased from 54% to 93%.
Conclusion: These data provide preliminary evidence to suggest that the response to Pilates exercise therapy in patients with LBP can be predicted from variables collected from the clinical examination. If subsequently validated in a randomized clinical trial, this prediction rule may be useful to improve clinical decision-making in determining which patients are most likely to benefit from Pilates exercise therapy.
Please contact Lise for questions and to communicate interest in future low back pain research: firstname.lastname@example.org