Table 2.
Components of each treatment protocol used in the trial
| Treatment component | DHR | NRDP | RDP | ZJD | MFP | Advice |
|---|---|---|---|---|---|---|
| Patho-anatomical/physiological explanation including generally favourable prognosis | ✔ | ✔ | ✔ | ✔ | X | ✔ |
| Advice in accordance with Indahl et al. [35] | X | X | X | X | X | ✔ |
| Explanation of pain physiology and central sensitisation for ongoing pain with multiple biopsychosocial contributing factors | O | O | O | O | ✔ | X |
| Discussion of treatment options available | ✔ | ✔ | ✔ | ✔ | ✔ | X |
| Discussion of timeframes and expectations | ✔ | ✔ | ✔ | ✔ | ✔ | X |
| Posture education including lifting technique | ✔ | ✔ | ✔ | O | X | X |
| Teaching pacing and graded exposure strategies | ✔ | ✔ | ✔ | O | ✔ | X |
| Goal setting (establishment and regular reviews) | ✔ | ✔ | ✔ | ✔ | ✔ | X |
| Specific motor control training (transversus abdominis, lumbar multifidus and pelvic floor) | ✔ | ✔ | ✔ | ✔ | O | X |
| Teaching and supervision of functional restoration exercises in the clinic with additional sessions at home | ✔ | ✔ | X | X | ✔ | X |
| Demonstration of functional restoration exercises for implementation at home | X | X | ✔ | ✔ | X | X |
| Education regarding pain management strategies (pharmacological) | O | O | O | O | O | X |
| Education regarding pain management strategies (non-pharmacological) | O | O | O | O | O | X |
| Strategies to control inflammation | O | O | O | O | O | X |
| Application of strapping tape to lumbar spine | ✔ | ✔ | ✔ | O | X | X |
| Discussion of strategies to manage work issues | O | O | O | O | O | X |
| Directional preference management (McKenzie program)...includes mechanical loading strategies, repeated movements, walking program, taping, and postural advice | O | O | ✔ | X | X | X |
| Manual therapy | X | X | X | ✔ | X | X |
| Relaxation strategies | O | O | O | O | O | X |
| Sleep strategies | O | O | O | O | O | X |
| Management of increases in pain | O | O | O | O | X | X |
| Explanation of improvement in function V's improvement in pain | O | O | O | O | X | X |
| Cognitive restructuring of counterproductive beliefs (via use of information sheets relating to the above treatment components) | ✔ | ✔ | ✔ | ✔ | ✔ | X |
| Behavioural strategies to support and reinforce the education and information provided and to modify unproductive behaviours | ✔ | ✔ | ✔ | ✔ | ✔ | X |
| Transfer to MFP protocol if inadequate progress with pathoanatomical approach after five sessions | O | O | O | O | X | X |
| Targeted cognitive restructuring and behavioural modification based on review of the Orebro Musculoskeletal Pain Questionnaire subscales | X | X | X | X | ✔ | X |
| Specific discussion of psychosocial barriers as an explanation for failure to recover | O | O | O | O | ✔ | X |
| Discharge planning for long-term management | ✔ | ✔ | ✔ | ✔ | ✔ | X |
✔ = component mandatory, O = component optional/if required, X = component not allowed, DHR = disc herniation with associated radiculopathy, NRDP = non-reducible discogenic pain, RDP = reducible discogenic pain, ZJD = zygapophyseal joint dysfunction, MFP = multi-factorial persistent pain