Assessment of variability in traction interventions for patients with low back pain: a systematic review

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

Previous systematic reviews have concluded that lumbar traction is not effective for patients with low back pain (LBP), yet many clinicians continue to assert its clinical effectiveness.

Objective

To systematically identify randomized controlled trials (RCTs) of traction and explore the variability of traction interventions used in each RCT.

Method

A literature search started in September 2016 to retrieve systematic reviews and individual RCTs of lumbar traction. The term “lumbar traction” and other key words were used in the following databases: Cochrane Registry, MEDLINE, EMBASE, and CINAHL. The retrieved systematic reviews were used to extract individual RCTs. The most current systematic review included RCTs from inception until August 2012. We performed an additional literature search to update this systematic review with newer RCTs published between September 2012 and December 2016. All of the identified RCTs were combined and summarized into a single evidence table.

Results

We identified a total of 37 traction RCTs that varied greatly in their method of traction intervention. The RCTs included several types of traction: mechanical (57%), auto-traction (16%), manual (10.8%), gravitational (8.1%) and aquatic (5.4%). There was also great variability in the types of traction force, rhythm, session duration and treatment frequency used in the RCTs. Patient characteristics were a mixture of acute, subacute and chronic LBP; with or without sciatica.

Conclusion

There is wide variability in the type of traction, traction parameters and patient characteristics found among the RCTs of lumbar traction. The variability may call into question the conclusion that lumbar traction has little no or value on clinical outcomes. Also, this variability emphasizes the need for targeted delivery methods of traction that match appropriate dosages with specific subgroups of patients with LBP.

Related collections

Most cited references 46

Record: found
Abstract: not found
Article: not found

A Clinical Prediction Rule for Classifying Patients with Low Back Pain Who Demonstrate Short-Term Improvement With Spinal Manipulation

Timothy Flynn, Julie M Fritz, Julie Whitman … (2002)

0 comments Cited 90 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Subgrouping patients with low back pain: evolution of a classification approach to physical therapy.

Jennifer Cleland, John Childs, Julie M Fritz (2007)

The development of valid classification methods to assist the physical therapy management of patients with low back pain has been recognized as a research priority. There is also growing evidence that the use of a classification approach to physical therapy results in better clinical outcomes than the use of alternative management approaches. In 1995 Delitto and colleagues proposed a classification system intended to inform and direct the physical therapy management of patients with low back pain. The system described 4 classifications of patients with low back pain (manipulation, stabilization, specific exercise, and traction). Each classification could be identified by a unique set of examination criteria, and was associated with an intervention strategy believed to result in the best outcomes for the patient. The system was based on expert opinion and research evidence available at the time. A substantial amount of research has emerged in the years since the introduction of this classification system, including the development of clinical prediction rules, providing new evidence for the examination criteria used to place a patient into a classification and for the optimal intervention strategies for each classification. New evidence should continually be incorporated into existing classification systems. The purpose of this clinical commentary is to review this classification system, its evolution and current status, and to discuss its implications for the classification of patients with low back pain.

0 comments Cited 67 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

A treatment-based classification approach to low back syndrome: identifying and staging patients for conservative treatment.

A Delitto, W Bowling, Richard Erhard (1995)

We present a treatment-based classification approach to the conservative management of low back syndrome. The approach has three levels of classification based on historical information, behavior of symptoms, and clinical signs. We first distinguish patients whose conservative care can be managed predominantly and independently by physical therapists versus patients who require consultation with other services (eg, psychology) or who require referral because of possible serious nonmusculoskeletal pathology. Once patients who can be managed by physical therapists are identified, the next level of classification is to stage their condition with regard to severity. We propose three stages: stage I for patients in the acute phase where the therapeutic goal is symptom relief, stage II for patients in a subacute phase where symptom relief and quick return to normal function are encouraged, and stage III for selected patients who must return to activities requiring high physical demands and who demonstrate a lack of physical conditioning necessary to perform the desired activities safely. The remainder of the article focuses on a third level of classification for stage I only in which patients are classified into distinct categories that are treatment-based and that specifically guide conservative management. The entire approach is diagnosis based, with specific algorithms and decision rules as well as examples presented.

0 comments Cited 65 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Muhammad Alrwaily:

ORCID: http://orcid.org/0000-0001-9406-6788

muhammad.alrwaily@hsc.wvu.edu

Mohammed Almutiri: mka30@pitt.edu

Michael Schneider: mjs5@pitt.edu

Journal

Journal ID (nlm-ta): Chiropr Man Therap

Journal ID (iso-abbrev): Chiropr Man Therap

Title: Chiropractic & Manual Therapies

Publisher: BioMed Central (London )

ISSN (Electronic): 2045-709X

Publication date (Electronic): 17 September 2018

Publication date PMC-release: 17 September 2018

Publication date Collection: 2018

Volume: 26

Electronic Location Identifier: 35

Affiliations

[1 ]ISNI 0000 0001 2156 6140, GRID grid.268154.c, Division of Physical Therapy, School of Medicine, , West Virginia University, ; 1 Medical Center Drive, P.O. Box 9226 – Room 8304, Morgantown, WV 26506 USA

[2 ]King Fahad Specialist Hosptial, Dammam, Saudi Arabia

[3 ]ISNI 0000 0004 0411 0012, GRID grid.440757.5, Department of Physical Therapy, School of Applied Medical Sciences, , Najran University, ; King Abdulaziz Rd, PO Box 1988, Najran, 61441 Saudi Arabia

[4 ]ISNI 0000 0004 1936 9000, GRID grid.21925.3d, Department of Physical Therapy, School of Health and Rehabilitation Sciences, , University of Pittsburgh, ; Bridgeside Point 1, 100 Technology Drive, Suite 210, Pittsburgh, PA 15219 USA

Author information

Muhammad Alrwaily http://orcid.org/0000-0001-9406-6788

Article

Publisher ID: 205

DOI: 10.1186/s12998-018-0205-z

PMC ID: 6139896

SO-VID: 662f5450-be42-4367-a30e-4c33938e222f

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.