Analysis of Motor Control in Patients With Low Back Pain: A Key to Personalized Care?
Jaap H van Dieën, N Peter Reeves, Greg Kawchuk and 2 others
PMID 29895232WHAT IT FOUND
Subgrouping low back pain by motor control is plausible, and existing clinical systems can classify patients reliably, but evidence that matched treatment improves outcomes is mixed, so it is not yet a tested basis for personalized care.
Key findings
01No strong evidence yet supports subgroup-based treatment for low back pain.
02Existing clinical subgrouping systems used by physical therapists can classify patients reliably, but they were not developed specifically to classify motor control.
03Trials testing motor-control subgrouping are mixed: two trials matching exercise to movement subgroups showed no benefit over general exercise, while two recent trials showed superior long-term outcomes with individualized motor control exercise, but one added a wearable biofeedback device and another targeted cognitive, motor control, and lifestyle factors, so the effect of motor control alone cannot be separated.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a review, not a single trial, so it does not show what happens when a therapist uses motor-control subgrouping. The authors did not establish cutoff scores or a minimal objective test battery that separates tight control, normal control, and loose control. Patients may have both tight and loose motor-control features, and motor control may change with the task or threat level. Pain mechanisms differ, and motor-control training may not address central sensitization as the main mechanism. The positive trials combined motor control with other components, such as wearable biofeedback or cognitive and lifestyle factors, so the effect of any single component cannot be separated. The paper mainly discusses physical therapist classification systems, so it gives little direct guidance for occupational therapists or speech-language pathologists.
The easy way to misread this
Do not read the positive individualized motor control exercise trials as proof that motor control subgrouping works. Two trials found no benefit over general exercise, and the positive trials combined motor control with biofeedback or cognitive and lifestyle factors.