Hides 1996.
| Methods | Randomised controlled trial | |
| Participants | 41 patients recruited from an accident and emergency department at a hospital over a 6‐month period Inclusion criteria: Men and women were eligible for the study in the first instance if they were 18 to 45 years of age and were experiencing their first episode of unilateral, mechanical LBP for less than 3 weeks Exclusion criteria: previous history of LBP or injury, previous lumbar surgery, spinal abnormalities indicated on radiographs, neuromuscular or joint disease, reflex and/or motor signs of nerve root compression or cauda equina compression, evidence of systemic disease, carcinoma or organ disease, pregnancy, any sports or fitness training involving the low back muscles done in the past 3 months |
|
| Interventions | Medical management group: advice on bed rest and absence from work and prescription of medication. Minimal bed rest (1 to 3 days) and only minor analgesics were prescribed. These analgesics included aspirin, paracetamol, combinations of low doses of codeine and aspirin, non‐steroidal anti‐inflammatory agents, Digestics and Capadex. Prescription of Valium was also allowable Exercise therapy: Therapeutic exercises were designed to re‐educate the multifidus muscle in its stabilising role. They involved facilitating an active, isometric multifidus contraction in co‐contraction with deep abdominal muscles. Participants performed the contraction in the standing position with the lumbar spine in a neutral position. Contraction of the multifidus was confirmed by real‐time ultrasound imaging |
|
| Outcomes | Pain: McGill Pain Questionnaire and visual analogue scales Disability: Roland Morris Disability Index |
|
| Notes | Financial support from The Menzies Foundation, The JP Kelly Mater Research Foundation, The Wenkart Foundation, The Physiotherapy Research Foundation and the Manual Therapy Special Group (Australia) | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | "Random assignment to the control or treatment group was achieved by selecting the group number from sealed, shuffled envelopes" |
| Allocation concealment (selection bias) | Low risk | "Random assignment to the control or treatment group was achieved by selecting the group number from sealed, shuffled envelopes" |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | No mention of any attempts to blind participants |
| Blinding of personnal/care provider (performance bias) All outcomes | High risk | No mention of any attempts to blind care provider |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | "Assessments were performed by two independent examiners, who were blinded to group allocation and patient presentation"; outcome measures were self reported, thus, assessor was not considered blinded |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Percentages of withdrawals and dropouts were within the acceptable rate |
| Intention‐to‐treat analysis | Unclear risk | Not described |
| Selective reporting (reporting bias) | Low risk | Published report clearly included all expected outcomes |
| Group similarity of baseline (selection bias) | High risk | Groups were not similar at baseline regarding outcome disability |
| Co‐interventions (performance bias) | Unclear risk | Not described |
| Compliance (performance bias) | Unclear risk | Not described |
| Timing of outcome assessment (detection bias) | Low risk | All important outcomes assessments for both groups were measured at the same time |
AROM: active range of motion.
CSE: core stability exercise.
LBP: low back pain.
LM: lumbar multifidus.
OSW: Modified Oswestry Questionnaire.
ROM: range of motion.
TrA: transversus abdominis