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Effectiveness of back school versus McKenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial
Garcia AN, Costa LCM, da Silva TM, Gondo FLB, Cyrillo FN, Costa RA, Costa LOP
Physical Therapy 2013 Jun;93(6):729-747
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Back school and McKenzie methods are popular active treatment approaches that include both exercises and information for patients with chronic non-specific low back pain. OBJECTIVE: To compare the effectiveness of back school and McKenzie methods in patients with chronic non-specific low back pain. DESIGN: Prospectively registered, two-arm, randomized controlled trial with a blinded assessor. SETTING: This study was conducted in the outpatient physical therapy clinic in Sao Paulo, Brazil. PATIENTS: 148 patients with chronic non-specific low back pain. INTERVENTIONS: Four-week treatment program (one session/week) based upon the back school (delivered in group) or McKenzie (delivered individually) principles. The participants were also instructed to perform a daily set of home exercises. MEASUREMENTS: Clinical outcomes were obtained at follow up appointments at 1, 3 and 6 months after randomization. Primary outcomes were pain intensity (measured by the 0 to 10 pain numerical rating scale) and disability (measured by the 24-item Roland Morris Disability Questionnaire) 1 month after randomization. Secondary outcomes were pain intensity and disability at 3 and 6 months after randomization; quality of life (measured by World Health Organization Quality of Life Bref) at 1, 3 and 6 months after randomization and trunk flexion range of motion measured by an inclinometer at 1 month after randomization. The data were collected by a blinded assessor. RESULTS: Patients allocated to the McKenzie group had greater improvements in disability at one month; mean effect 2.37 points (95% CI 0.76 to 3.99) but not for pain (0.66 points, 95% CI -0.29 to 1.62). No between-group differences were observed for all secondary outcomes. LIMITATIONS: It was not possible to monitor the home exercises program. Therapists and patients were not blinded. CONCLUSIONS: The McKenzie method (a more resource intensive intervention) was slightly more effective than back school for disability, but not for pain intensity immediately after treatment in patients with chronic low back pain.

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