Derivation of a Preliminary Clinical Prediction Rule for Identifying a Sub-Group of Patients With Low Back Pain Likely to Benefit From Pilates-Based Exercise

Stolze LR, Allison SC, Childs JD. J Orthop Sports Phys Ther 2012 Jan 25 [Epub ahead of print]

Low back pain is a common cause of disability in our society.  Studies are underway to better characterize and differentiate the type of low back pain that patients experience.  Clinicians in rehabilitation have been implementing specific exercise programs (such as Pilates) for low back pain patients as a therapeutic intervention but it is unclear how to identify patients that may respond best to certain exercise programs.  The researchers conducted this prospective cohort study to determine if certain factors from a baseline clinical examination could identify patients with low back pain most likely to benefit from the Pilates-based exercises.  Four physical therapists trained in a comprehensive Pilates training program assessed 96 patients at baseline and after 8 weeks of treatment with a physical exam and modified Oswestry Disability Questionnaire (ODQ).  Treatment consisted of a standardized Pilates-based exercise program implemented twice a week for 8 weeks.  After 8 weeks a post-test ODQ was administered.  Treatment was defined as successful if the patient experienced at least a 50% improvement in their ODQ score.  The authors found that 54% of the patients treated with this Pilates-based program met the treatment success threshold.  The authors identified 5 potential predictors of success: total trunk flexion ROM of 70 degrees or less, duration of symptoms of 6 months or less, no leg symptoms in previous week, body mass index of 25 kg/m2 or greater, and left or right hip average internal/external rotation of 25 degrees or greater.  If a patient had 3 of the 5 attributes, the positive likelihood ratio  for treatment success with Pilates was 10.64; i.e., if a patient met 3 of the 5 predictors, the treatment was 10 times more likely to be successful than if less than 3 predictors were present.

In 2011 Lim et al published a systemic review that Pilates-based exercise is superior to minimal intervention for pain but that current evidence does not establish superiority to other forms of exercise for low back pain patients.  With Pilates gaining more popularity, more research will be needed to determine if this is a safe and effective treatment for certain musculoskeletal problems.  The purpose of this study was to derive a preliminary clinical prediction rule to identify a sub-group of patients with low back pain that would benefit from the Pilates-based exercise.   I agree with the authors that validating this study with a randomized controlled trial would be the next step to be able to recommend this as a treatment option.  Some of the advantages of Pilates would be the ability to exercise in a group setting and the whole-body health benefits.  Have any of your patients benefited from Pilates or other types of exercise programs such as yoga?

Written by: Kris Fayock, MD and Marc Harwood, MD
Reviewed by: Jeffrey Driban

Related Posts:
Trunk Muscle Activity During Various Exercises
Getting “Back” on Track – Abdominal Bracing, Rehabilitation, and Low Back Pain
Accuracy of Clinical Tests to Identify a Subset of Patients with Low Back Pain

Stolze LR, Allison SC, & Childs JD (2012). Derivation of a Preliminary Clinical Prediction Rule for Identifying a Sub-Group of Patients With Low Back Pain Likely to Benefit From Pilates-Based Exercise. The Journal of Orthopaedic and Sports Physical Therapy PMID: 22281950