OBJECTIVES

The study aimed to compare the influence of three clinical decision making methods (Treatment-based classification- TBC, Mechanism-based classification- MBC and Impairment-based classification- IBC) on patient and healthcare outcomes in adults with mechanical low back pain (MLBP).

METHODS

An observer-blinded multi-center randomized clinical trial was performed on 38 adults (26 male, 12 female) with physician-diagnosed MLBP. Study participants were allocated treatments in concealed manner, and multi-stage randomization was done to receive therapy based on either of three decision making models, Group 1- TBC, Group 2- MBC and Group 3- IBC. Treatments were administered by therapists blinded to study, and were prescribed thrice weekly for 3 weeks. Pre and post outcome measures included Modified Oswestry Disability Index (M-ODI), Fear- avoidance beliefs questionnaire (FABQ), length of hospital stay (or treatment LOHS), healthcare cost (HCC) and Back Pain Outcomes Questionnaire (BPOQ). Within-group and between-group differences were analysed using two-way Analysis of Variance (ANOVA) and Bonferonni post-hoc testing at 95% confidence interval using SPSS version 22 for Windows .

RESULTS

MBC group had statistically significant (p<.05) improvements in all outcome measures, with between-group difference, while the TBC group had improvements in M-ODI, BPOQ but not other measures, and IBC improved only the FABQ score.

CONCLUSIONS

MBC group had reduced M-ODI scores, FABQ scores, LOHS, HCC and increased BOPQ scores compared to TBC and IBC groups in this study.