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.

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.

Treatment of patella alta with taping, exercise, mobilization, and functional activity modification: a case report.

Knee pain associated with patella alta (PA) can limit involvement in sport or work activities and prevent an individual from performing basic functional tasks. This case report describes the use of patellar taping to treat an individual with PA. The patient was a 56 year-old female with bilateral knee pain associated with PA. The focus of treatment was to decrease pain during functional activities by using tape to correct patella alignment. The patient was also instructed on specific exercises and mobilizations. The primary outcome measure was the ADL subscale of the Knee Outcome Survey (ADL-KOS). Initially, the patient scored a 50 on the ADL-KOS and rated her function at 30% of normal. She demonstrated symptom improvement when tape was applied appropriately and was, therefore, instructed in tape application. At discharge, the patient scored a 56 on the ADL-KOS and rated her function at 70% of normal. This case demonstrates the effective use of a taping method for the treatment of pain associated with PA. Taping appears to be a safe, conservative, and cost-efficient measure to manage symptoms and to improve activity tolerance in this patient.

Development and preliminary reliability testing of an assessment of patient independence in performing a treatment program: standardized scenarios.

BACKGROUND: Physical therapists often assess patient independence through observation; however, it is not known if therapists make these judgments reliably. We have developed a standardized method to assess a patient's ability to perform his or her treatment program independently. OBJECTIVES: To develop a standardized assessment of patient independence in performance of a treatment program and examine the intra- and inter-rater reliability decisions made by two physical therapists. DESIGN: Test-retest. METHODS: An assessment of patient independence in performance was developed. Standardized patient scenarios were used to assess the intra- and inter-tester reliability of two physical therapists. Percentage of agreement (%) and kappa's coefficient (k and k(w)) indexed rater reliability. RESULTS: Intra-rater reliability of therapist 1 was as follows: knowledge: % = 95, k = 0.90; performance: % = 95, k(w) = 0.82. Intra-rater reliability of therapist 2 was as follows: knowledge: % = 85, k = 0.68; performance: % = 94, k(w) = 0.80. Inter-rater reliability for knowledge was % = 91 and k = 0.79 and for performance was % = 91 and k(w) = 0.72. CONCLUSION: Trained therapists displayed substantial to excellent intra-rater reliability and substantial inter-rater reliability in assessing a patient's independence in a treatment program. :