Oliveria et al just published a systematic review with meta analysis in Arthritis Care and Research looking at the effectiveness of self-management for low back pain.  Here is the conclusion:

Physical Therapy. Excerpt from Oliveria et al 2012
Physical Therapy. Excerpt from Oliveria et al 2012

Not what I would expect, nor I’m sure the authors!  This goes against any clinician’s goal, no matter their approach.  We want patients to be self-responsible and have active care in their bodies.  This just makes sense right.  A dentist would never say do not floss or brush your teeth daily due to one study. But, be cautious with interpreting the results.  Let’s delve further.

I want to thank colleagues of mine (Eric Jorde and Alex Siyufy) whom I shared this article with for their opinion.  I respect their perspective and it is well worth to share with all readers their experience and expertise.

Dr. Siyufy examined the actual studies. If you look at the self-management strategies, you see that most of the studies allot pamphlets, back school, websites, booklets or even leaflets.  Then others are listed just as self-management.  We know the former just does not work.  I have seen minimal effects myself with any of these tactics in my practice and don’t even consider them now.

Dr. Jorde looked at this from another angle.  He mentioned this is another example of running a systematic review on symptoms, not a diagnosis.  It is like trying to find the effectiveness of treatment for chest pain, versus actually treating symptoms arising from the heart (myocardial infarction) or esophagus (GERD).  We know the treatment is different for these two entities.

I would like to see this same type of analysis performed in about 5 years from now with studies looking at patients being subgrouped into classifications based on directional preference, centralization, manipulation, core stabilization, etc.  We are moving more into this now and I find better results with my patients.  It leads to a more specific movement approach with fewer exercises, improves compliance and outcomes.  It worked for me (read here).

Listen to the authors. Be well advised with systematic reviews.  Maybe we should just focus on case reports.

Physical Therapy: Excerpt from Oliveria et al
Physical Therapy: Excerpt from Oliveria et al




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