Functional Movement Training for Recurrent Low Back Pain: Lessons From a Pilot Randomized Controlled Trial

Schenkman, Margaret L.; Jordan, Sharon; Akuthota, Venu; Roman, Matthew; Kohrt, Wendy M.; Hearty, Thomas; Cleary, Catherine; Backstrom, Karen Maloney

doi:10.1016/j.pmrj.2008.10.004

« Previous Next »PM&R
Volume 1, Issue 2 , Pages 137-146, February 2009

Functional Movement Training for Recurrent Low Back Pain: Lessons From a Pilot Randomized Controlled Trial

Margaret L. Schenkman, PhD, PT
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Aurora, CO^⁎
Sharon Jordan, MA, PT
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Aurora, CO^⁎
Venu Akuthota, MD
- The Spine Center at University of Colorado Hospital, Department of Physical Medicine and Rehabilitation, University of Colorado Denver School of Medicine, PO Box 6508, Mail Stop F-493, Aurora, CO 80045^⁎
- Address correspondence to V.A.
Matthew Roman, PT, OMT
- Department of Physical Therapy, Duke University Medical School, Durham, NC^⁎
Wendy M. Kohrt, PhD
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Denver, Aurora, CO^⁎
Thomas Hearty, MD, DPT
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Denver, Aurora, CO^⁎
Catherine Cleary, PT
- The Spine Center at University of Colorado Hospital, Aurora, CO^⁎
Karen Maloney Backstrom, MS, PT, OCS
- Private Practice, Denver, CO^⁎

Received 7 March 2008; accepted 13 October 2008. published online 29 December 2008.

Objective

Despite considerable effort to reduce low back pain (LBP), approximately 60% of patients have recurrence after their first episode. The high rate of recurrence suggests that more effective intervention approaches are needed. This randomized, controlled feasibility trial was designed to compare disability, physical functional capacity, and pain outcomes at 2, 6, and 12 months for 2 conventional and 1 novel physical therapy (functional movement training) intervention for recurrent LBP.

Design

Randomized, controlled feasibility trial.

Setting

University hospital outpatient physical therapy clinic.

Participants

Sixty-one participants (60% female) with recurrent LBP.

Interventions

Subjects were randomized to 1 of 3 intervention groups: group 1 had a single session consisting of standard back pain education; group 2 had 6 sessions in 8 weeks of conventional physical therapy; and group 3 had 6 sessions in 8 weeks of a novel method of functional movement training. Change from baseline was used to determine within-group changes and between-group differences for participants who finished each time point (2, 6, and 12 months). Changes were evaluated using analysis of variance and Newman-Keuls post hoc analysis.

Main Outcome Measures

The primary outcome measure was the novel Continuous Scale Physical Functional Performance test (CS-PFP), a measure of actual physical functional capacity. Secondary measures included the revised Oswestry Disability Index, a measure of pain-related disability, the Roland Morris Disability Questionnaire, and a standard visual analogue pain scale.

Results

Of the participants, 67% provided data at 2 months and 44% provided information at 12 months. Raw change scores were evaluated at 2, 6, and 12 months. While no statistical significance was reached with any outcome measure, the trends suggested little change for group 1 (education) and suggested that greatest improvement in function may occur in group 3 (functional movement training). In particular, at 2 months, the CS-PFP change scores revealed a trend (P=.072) toward greater improvement in groups 2 (conventional physical therapy) and 3 (functional movement training) compared with group 1. At 12 months, Oswestry Disability Index and CS-PFP scores also trended toward significance for groups 2 and 3 (P=.7 and .9, respectively). Mean change scores were also calculated and revealed groups 2 and 3 had improved by 2 months and this improvement remained stable at the 1-year mark. Trends in the direction of best improvement occurred for those in the functional movement training group.

Conclusion

A large-scale randomized, controlled trial is warranted to determine whether an intervention based on functional movement training is superior to conventional, impairment-based intervention for individuals with recurrent LBP.