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Comparison of Classification-Based Physical Therapy With Therapy Based on Clinical Practice Guidelines for Patients with Acute Low Back Pain: A Randomized Clinical Trial

Fritz, Julie M. PhD, PT, ATC*; Delitto, Anthony PhD, PT, FAPTA*†; Erhard, Richard E. DC, PT*‡

Randomized Trial

Study Design. A randomized clinical trial was conducted.

Objective. To compare the effectiveness of classification-based physical therapy with that of therapy based on clinical practice guidelines for patients with acute, work-related low back pain.

Summary of Background Data. Clinical practice guidelines recommend minimal intervention during the first few weeks after acute low back injury. However, studies supporting this recommendation have not attempted to identify which patients are likely to respond to particular interventions.

Methods. For this study, 78 subjects with work-related low back pain of less than 3 weeks duration were randomized to receive therapy based on a classification system that attempts to match patients to specific interventions or therapy based on the Agency for Health Care Policy and Research guidelines. The subjects were followed for 1 year. Outcomes included the impairment index, Oswestry scale, SF-36 component scores, satisfaction, medical costs, and return to work status.

Results. After adjustment for baseline factors, subjects receiving classification-based therapy showed greater change on the Oswestry (P = 0.023) and the SF-36 physical component (P = 0.029) after 4 weeks. Patient satisfaction was greater (P = 0.006) and return to full-duty work status more likely (P = 0.017) after 4 weeks in the classification-based group. After 1 year, there was a trend toward reduced Oswestry scores in the classification-based group (P = 0.063). Median total medical costs for 1 year after injury were $1003.68 for the guideline-based group and $774.00 for the classification-based group (P = 0.13).

Conclusions. For patients with acute, work-related low back pain, the use of a classification-based approach resulted in improved disability and return to work status after 4 weeks, as compared with therapy based on clinical practice guidelines. Further research is needed on the optimal timing and methods of intervention for patients with acute low back pain.

From the *Department of Physical Therapy, University of Pittsburgh,

†Centers for Rehab Services, Pittsburgh, and the

‡Comprehensive Spine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Funded by a Clinical Research Center grant from the Foundation for Physical Therapy.

Acknowledgment date: May 17, 2001.

First revision date: August 9, 2001.

Second revision date: October 25, 2001.

Acceptance date: November 27, 2002.

The submitted manuscript does not contain information about medical devices or drugs.

Foundation funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this article.

Address correspondence and reprint requests to Julie M. Fritz, PhD, PT, Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260; E-mail: jfritz@pitt.edu

© 2003 Lippincott Williams & Wilkins, Inc.