J Orthop Sports Phys Ther. 2021 Nov 16;1-48. doi: 10.2519/jospt.2021.10593. Online ahead of print.
Scott A Burns
PMID: 34784246 DOI: 10.2519/jospt.2021.10593
Abstract
Objective: To determine if adding hip treatment to usual low back pain care improved disability and pain for individuals with low back pain (LBP) and a concurrent hip impairment.
Design: Randomized controlled trial.
Methods: Seventy-six (76) participants (age ≥ 18, ODI ≥ 20%, NPRS ≥ 2 points) with LBP and a concurrent hip impairment were randomly assigned to either: lumbar spine only (LBO) (n= 39) or lumbar spine and hip treatments (LBH) (n= 37). The individual treating clinicians decided which specific low back treatments to administer for the LBO group. Treatments aimed at the hip (LBH group) included manual therapy, exercise, and education, selected by the therapist from a pre-determined set of treatments. Primary outcomes were disability and pain measured by the Oswestry Disability Index (ODI) and Numeric Pain Rating Scale (NPRS) at baseline, 2 weeks, discharge, 6 months, and 12 months. The secondary outcomes were fear avoidance beliefs (FABQ, work and physical activity scales), global rating of change, patient acceptable symptom state and physical activity level. We used mixed model 2×3 ANOVA to examine group x time interaction effects (intention to treat analysis).
Results: Data were available for 68 patients at discharge (n = 33 LBH, n = 35 LBO) and 48 at 12 months (n=24 LBH, n = 24 LBO). There were no between-group differences in disability at discharge (-5.0, 95% CI: -10.9, 0.89, p=0.09), 12 months (-1.0, 95% CI: -4.44, 2.35, p=0.54), or at other timepoints. There were no between-group differences in pain at discharge (-0.2, 95% CI: -1.03, 0.53, p = 0.53), 12 months (0.1, 95% CI: -0.53, 0.72, p=0.76), or at other timepoints. There were no between-group differences in secondary outcomes, except for higher FABQ (work) scores in the LBH group at 2 weeks (-3.35, 95% CI: -6.58, -0.11, p=0.04) and discharge (-3.45, 95% CI: -6.3, 0.61, p=0.02).
Conclusion: Adding treatments aimed at the hip to usual low back physical therapy did not provide additional short- or long-term benefits in reducing disability and pain for individuals with LBP and a concurrent hip impairment. Clinicians may not need to include hip treatments to achieve reductions in low back disability and pain for individuals with LBP and a concurrent hip impairment. J Orthop Sports Phys Ther, Epub 16 Nov 2021. doi:10.2519/jospt.2021.10593.