In 2012, a study conducted by a team of researchers, including F. Cecchi, S. Negrini, and others, has shed new light on the effectiveness of different conservative treatments for chronic low back pain (cLBP). The study, which analyzed data from a randomized trial involving 210 outpatients, aimed to identify the predictors of response to three common treatments: back school (BS), individual physiotherapy (IP), and spinal manipulation (SM).

The researchers evaluated the patients using the Roland Morris Disability Questionnaire (RM) both before and after treatment. A decrease in the RM score of less than 2.5 was used to classify patients as non-responders. Of the 205 patients who completed the treatment (140 women, average age 58), 72 were identified as non-responders, representing 34.2% of the cohort.

Among the three treatments, spinal manipulation emerged as the most effective, showing the highest functional improvement and the lowest rate of non-responders. The study’s multivariable logistic regression analysis revealed that a lower baseline RM score (indicating less disability) and the type of treatment received were significant predictors of non-response. Specifically, patients with a lower baseline RM score were more likely to be non-responders to BS and IP, but this was not the case for SM.

Interestingly, the findings suggested that patients with lower pain-related disability (those in the lowest tertile of baseline RM score, less than 6) were less likely to benefit from BS and IP. However, the effectiveness of SM was consistent across all levels of baseline RM scores.

The study concludes that for patients with cLBP, particularly those with lower levels of pain-related disability, spinal manipulation should be considered as the first line of conservative treatment. This insight could significantly impact clinical rehabilitation strategies, providing a more targeted approach to managing chronic low back pain.

These results underscore the importance of tailoring treatment plans to individual patient characteristics to maximize therapeutic outcomes. As chronic low back pain remains a prevalent and challenging condition, such personalized approaches are crucial in improving patient quality of life and functional capacity.

Reference: Cecchi, F., Negrini, S., Pasquini, G., Paperini, A., Conti, A. A., Chiti, M., & Molino Lova, R. (2012). Predictors of functional outcome in patients with chronic low back pain undergoing back school, individual physiotherapy or spinal manipulation. European Journal of Physical and Rehabilitation Medicine, 48(3), 371-378.