Classification-guided versus generalized postural intervention in subgroups of nonspecific chronic low back pain: a pragmatic randomized controlled study

Study Design. Pragmatic randomized controlled single-blinded study. Objective. To compare the effects of the classification system guided postural intervention (CSPI) with generalized postural intervention (GPI) in subgroups of non-specific chronic low back pain (NSCLBP). Summary of Background Data. Spinal motor control impairments and the associated alterations in spinal postures adopted by patients with NSCLBP are highly variable. Research evaluating the effect of interventions that target the specific movement/posture impairments in NSCLBP subgroups is therefore warranted. Methods. A total of 49 NSCLBP patients with a classification of flexion pattern (n = 29) and active extension pattern (n = 20) control impairment were recruited from a large cohort study and randomly assigned into CSPI and GPI. The primary outcome was change in Roland Morris Disability Questionnaire (RMDQ), secondary outcomes were change in pain visual analogue scale (VAS), spinal repositioning sense including thoracic and lumbar absolute error (AE), variable error (VE), constant error (CE) and trunk muscle activity during sitting and standing. The intervention was evaluated at baseline, immediately post one-to-one intervention and post 4-week home-based training. Results. The CSPI produced statistically and clinically significant reduction in disability (4.2 [95% CI 2.9-5.3]) and pain (2 [1.3-2.6]) compared to minimal change in the GPI disability (0.4 [-0.8-1.6]) and pain (-0.2 [-0.5-0.9]). Repeated measures ANOVA revealed that CSPI significantly reduced AE in thoracic (sitting) and lumbar spine (standing) and CE in lumbar spine (standing) post one-to-one phase, although this was no longer significant at 4 weeks. Neither intervention had an effect on trunk muscle activity. Conclusion. Compared to minimal change in the GPI group, the CSPI produced statistically and clinically significant improvements in disability and pain outcomes and short-term improvements in some parameters of spinal repositioning sense in NSCLBP subgroups