Derivation of a preliminary clinical prediction rule for identifying a subgroup of patients with low back pain likely to benefit from Pilates-based exercise

STUDY DESIGN: Prospective cohort study. OBJECTIVE: To derive a preliminary clinical prediction rule for identifying a subgroup of patients with low back pain (LBP) likely to benefit from Pilates-based exercise. BACKGROUND: Pilates-based exercise has been shown to be effective for patients with LBP. However, no previous work has characterized patient attributes for those most likely to have a successful outcome from treatment. METHODS: Ninety-six individuals with nonspecific LBP participated in the study. Treatment response was categorized based on changes in the Oswestry Disability Questionnaire scores after 8 weeks. An improvement of 50% or greater was categorized as achieving a successful outcome. Thirty-seven variables measured at baseline were analyzed with univariate and multivariate methods to derive a clinical prediction rule for successful outcome with Pilates exercise. Accuracy statistics, receiver-operator curves, and regression analyses were used to determine the association between standardized examination variables and treatment response status. RESULTS: Ninety-five of 96 participants completed the study, with 51 (53.7%) achieving a successful outcome. A preliminary clinical prediction rule with 5 variables was identified: total trunk flexion range of motion of 70° or less, duration of current symptoms of 6 months or less, no leg symptoms in the last week, body mass index of 25 kg/m2 or greater, and left or right hip average rotation range of motion of 25° or greater. If 3 or more of the 5 attributes were present (positive likelihood ratio, 10.64), the probability of experiencing a successful outcome increased from 54% to 93%. CONCLUSION: These data provide preliminary evidence to suggest that the response to Pilates-based exercise in patients with LBP can be predicted from variables collected from the clinical examination. If subsequently validated in a randomized clinical trial, this prediction rule may be useful to improve clinical decision making in determining which patients are most likely to benefit from Pilates-based exercise

13Th International Conference On Conservative Management Of Spinal Deformities And First Joint Meeting Of The International Research Society On Spinal Deformities And The Society On Scoliosis Orthopaedic And Rehabilitation Treatment – Sosort-Irssd 2016 Meeting

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