- Title
- Physical therapy interventions directed at the hips for individuals with a primary compliant of low back pain
- Creator
- Burns, Scott A.
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Low back pain (LBP) is one of the primary conditions seen in outpatient musculoskeletal physical therapy clinics. The optimal intervention strategy continues to be elusive. One emerging area is the role of hip region impairments in the manifestation and persistence of LBP symptoms; however, the practice patterns of physical therapists related to the role of the hip region in individuals with LBP has never been studied. Additionally, there is a need for studies that examine long-term outcomes following treatment of the hip region in individuals with LBP. Purpose: The aims of this thesis were to investigate (1) clinical practice patterns related to physical therapy tests/measures/interventions directed at the hip region for individuals with LBP, (2) baseline patient characteristics that predict recovery from LBP following physical therapy directed at the lumbar spine and hip region, and (3) the short- and long-term effects of physical therapy interventions directed at the lumbar spine with or without hip interventions for individuals with LBP and a concurrent hip region impairment. Methods: This thesis comprises three studies to address the three aims of the thesis. (1) An anonymous electronic survey of physical therapists was conducted to investigate therapists’ perceived importance of hip region impairments in individuals with LBP, as well as their examination and intervention strategies aimed at the hip region when an individual presents with LBP. (2) A secondary analysis of a data set from a prior randomized controlled trial (RCT) to examine prognostic baseline patient characteristics that predict recovery from LBP symptoms in individuals with LBP (with or without hip region impairments) receiving physical therapy interventions targeting the lumbar spine and/or hip. (3) An RCT of individuals with LBP plus an identified hip region impairment to investigate the short- and long-term effectiveness of tailored physical therapy interventions directed at the lumbar spine with or without interventions directed at the hip region. Outcomes included pain, disability, and patient perception of recovery. Results: The survey received 1163 responses and 91% of respondents reported they ‘always or most of the time’ performed examination tests/measures directed at the hip region for individuals with LBP. The most common examination tests/measures were hip muscle strength testing (performed by 94% of respondents), hip joint passive range of motion assessment (91%), and hip muscle flexibility testing (90%). The most common interventions directed at the hip region were muscle strengthening exercises (utilized by 94% of respondents), muscle flexibility exercises (90%), and various hip joint manual therapy techniques (e.g., joint mobilization, 66%). The secondary analysis found that the four variables of body mass index (BMI) 25.4, an irritable condition as assessed by the therapist, baseline numeric pain rating scale (NPRS) score 4 points, and the presence of a concurrent hip problem best predicted recovery from LBP following physical therapy targeting the lumbar spine with or without treating the hips. These variables at baseline examination may assist the therapist determining a prognosis for the patient. In the RCT, 76 participants enrolled with 80% retained to discharge. There were no group x time interactions at discharge, 6 months or 12 months for pain or disability (p 0.05) indicating that the addition of hip interventions did not improve the outcomes. However, both groups experienced significant improvements in pain and disability (p 0.05) from baseline to discharge that were maintained at 6 and 12 months. Conclusions: Physical therapists treating individuals with LBP examine and provide interventions targeting the hip region the majority of the time. Interventions often utilized include hip muscle strengthening and stretching exercises with hip joint manual therapy being used less frequently. Since clinicians are providing interventions to the hip region for individuals with LBP, it may be helpful to determine what factors may predict a positive outcome with this approach. The presence of the four variables of an irritable condition, mild pain ratings, lower BMI and a concurrent hip problem improved the chances of recovery following physical therapy for LBP. The presence of a concurrent hip region impairment had the strongest odds ratio of achieving recovery following physical therapy. Therefore, the final study included individuals with LBP and a concurrent hip region impairment to determine if this treatment approach had superior outcomes for disability and pain. The addition of hip region interventions to low back interventions did not result in improved outcomes in the short- or long-term follow-ups. However, physical therapy interventions targeting the lumbar spine with or without interventions targeting the hips, are effective at reducing pain and disability in individuals with LBP and a concurrent hip problem. In conclusion, many physical therapists reported that hip region impairments play an important role in individuals with LBP, but interventions directed at the hips may not provide additional benefits. In the future, additional research needs to look whether there is a specific type of individual with LBP (e.g., mechanical, non-specific) with or without hip region impairments (e.g., decreased ROM or strength) or hip conditions (e.g., osteoarthritis, femoroacetabular impingement, tendinopathy) that respond better to this intervention strategy.
- Subject
- physiotherapy; low back; hip; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1440204
- Identifier
- uon:41104
- Rights
- Copyright 2022 Scott A. Burns
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 7 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 156 KB | Adobe Acrobat PDF | View Details Download |