Index to Chiropractic Literature
Index to Chiropractic Literature
My ICL     Sign In
Thursday, June 27, 2019
Index to Chiropractic LiteratureIndex to Chiropractic LiteratureIndex to Chiropractic Literature
Share:

ICL Home


For best results switch to Advanced Search.
Article Detail
Return to Search Results
ID 24180
Title Do MRI findings identify patients with chronic low back pain and Modic changes who respond best to rest or exercise: A subgroup analysis of a randomised controlled trial
URL http://chiromt.biomedcentral.com/articles/10.1186/s12998-015-0071-x
Journal Chiropr & Manual Ther. 2015 ;23(26):Online access only 9 p
Author(s)
Subject(s)
Peer Review Yes
Publication Type Article
Abstract/Notes

Background: No previous clinical trials have investigated MRI findings as effect modifiers for conservative treatment of low back pain. This hypothesis-setting study investigated if MRI findings modified response to rest compared with exercise in patients with chronic low back pain and Modic changes.

Methods: This study is a secondary analysis of a randomised controlled trial comparing rest with exercise. Patients were recruited from a specialised outpatient spine clinic and included in a clinical trial if they had chronic low back pain and an MRI showing Modic changes. All patients received conservative treatment while participating in the trial. Five baseline MRI findings were investigated as effect modifiers: Modic changes Type 1 (any size), large Modic changes (any type), large Modic changes Type 1, severe disc degeneration and large disc herniation. The outcome measure was change in low back pain intensity measured on a 0–10 point numerical rating scale at 14-month follow-up (n = 96). An interaction ≥ 1.0 point (0–10 scale) between treatment group and MRI findings in linear regression was considered clinically important.

Results: The interactions for Modic Type 1, with large Modic changes or with large Modic changes Type 1 were all potentially important in size (−0.99 (95 % CI −3.28 to 1.29), −1.49 (−3.73 to 0.75), −1.49 (−3.57 to 0.58), respectively) but the direction of the effect was the opposite to what we had hypothesized—that people with these findings would benefit more from rest than from exercise. The interactions for severe disc degeneration (0.74 (−1.40 to 2.88)) and large disc herniation (−0.92 (3.15 to 1.31)) were less than the 1.0-point threshold for clinical importance. As expected, because of the lack of statistical power, no interaction term for any of the MRI findings was statistically significant.

Conclusions: Three of the five MRI predictors showed potentially important effect modification, although the direction of the effect was surprising and confidence intervals were wide so very cautious interpretation is required. Further studies with adequate power are warranted to study these and additional MRI findings as potential effect modifiers for common interventions.

This abstract is reproduced with the permission of the publisher; click on the above link for free full text.


 

      Text (Citation) Tagged (Export) Excel
 
Email To
Subject
 Message
Format
HTML Text     Excel



Search Tips
  • Enclose phrases in "quotation marks".  Examples: "low back pain", "evidence-based"
  • Retrieve all forms of a word with an asterisk*, also called a wildcard or truncation.  Example: chiropract* retrieves chiropractic, chiropractor, chiropractors
  • Register an account in My ICL to save search histories (My Searches) and collections of records (My Collections)
Advanced Search Tips