“
“Summary of: Machado LAC et al (2010) The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial BMC Medicine 8: 10. [Prepared by Julia Hush, CAP Editor.] Question: Does the addition of McKenzie treatment to first-line care improve symptoms and function for patients with acute low back pain? Design: A randomised controlled trial with concealed allocation and blinded outcome assessment. Setting: 27 primary care medical practices in Sydney, Australia. Participants: Patients aged between 18 to selleck kinase inhibitor 80 years seeking

medical care from a primary care physician for a new episode of acute non-specific low back pain. Nerve root compromise, serious spinal pathology, and recent spinal surgery were exclusion criteria. Randomisation of

148 participants allotted 73 to the McKenzie treatment and first-line care group, and 73 to a first-line care only group. Interventions: Both groups received the following recommended first-line care for acute low back pain: advice to remain active and avoid bed rest, reassurance of a favourable prognosis and instructions to take paracetamol. In addition, the intervention group received Selleck MDV3100 McKenzie therapy, commenced within 48 h of their physician consultation. Treatment was provided by 15 accredited McKenzie therapists. Treatment for most patients encouraged directions of movement and postures that centralised pain. Patients received up to 6 treatment sessions over 3 weeks. They were provided with the book Treat Your Own Back, prescribed home exercises, and most were prescribed

lumbar rolls. Outcome measures: Primary outcomes were pain and global perceived effect. Pain was measured during the first 7 days, and at Weeks 1 and 3, with the Numerical Rating Scale scored from 0 (no pain) to 10 (worst pain possible), with a between-group difference of 1 unit considered clinically important. Patient-rated global perceived effect was assessed at 3 weeks on a –5 to 5 scale, anchored GPX6 at ‘vastly worse’ and ‘completely recovered.’ Secondary outcome measures were disability, function, global perceived effect at 1 week, persistent low back pain at 3 months, and use of additional health care services. Results: 138 participants provided data at 3 months. At Week 1, pain was less in the McKenzie treatment group by 0.4 points (95% CI –0.1 to –0.8). At Week 3, pain was less in the McKenzie treatment group by 0.7 points (95% CI –1.2 to –0.1). The groups did not differ on other outcomes. However, patients receiving McKenzie treatment sought less additional health care than those receiving only firstline care (p = 0.002).