Effectiveness of an extension-oriented treatment approach in a subgroup of subjects with low back pain: A randomized clinical trial

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.