Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial

Man Ther. 2016 Aug:24:52-64. doi: 10.1016/j.math.2016.04.003. Epub 2016 Apr 19.


Background: It is unknown if low back pain (LBP) outcomes are enhanced by classification-specific treatment based on the Movement System Impairment classification system. The moderating effect of adherence to treatment also is unknown.

Objectives: Compare the efficacy of a classification-specific treatment (CS) and a non classification-specific (NCs) treatment and examine the moderating effect of adherence on outcomes.

Design: 2 center, 2 parallel group, prospective, randomized, clinical trial.

Method: Participants with chronic LBP were classified and randomized. Self-report data was obtained at baseline, post-treatment, and 6 and 12 months post-treatment. The primary outcome was the modified Oswestry Disability Index (mODI; 0-100%). Treatment effect modifiers were exercise adherence and performance training adherence. An intention to treat approach and hierarchical linear modeling were used.

Results: 47 people received CS treatment, 54 people received NCs treatment. Treatment groups did not differ in mODI scores (p > 0.05). For both groups, scores improved with treatment (p < 0.05), plateaued at 6 months (p > 0.05), and minimally regressed at 12 months (p < 0.05). Performance training adherence had a unique, independent effect on mODI scores above and beyond the effect of exercise adherence (p < 0.05). There were no treatment group effects on the relationship between mODI scores and the two types of adherence (p < 0.05).

Conclusions: There were no differences in function between the two treatment groups (CS and NCs). In both treatment groups, people with chronic LBP displayed clinically important long-term improvements in function. When both forms of adherence were considered, the improvements were uniquely related to adherence to performance training.

Keywords: Adherence; Classification; Low back pain.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Exercise Therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Low Back Pain / classification*
  • Low Back Pain / physiopathology
  • Low Back Pain / therapy*
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data*
  • Prospective Studies
  • Self Report
  • Treatment Outcome
  • United States
  • Young Adult