Mechanical Traction Can it benefi t a subgroup of LBP patients? Study title: Is there a subgroup of patients with low back pain likely to benefi t from mechanical traction? Results of a randomized clinical trial and subgrouping analysis Author: Fritz, JM., et al. Publication information: Spine 2007; 32(26): E793-E800. Summary: Below R Dr.Shawn Thistle is the founder and president of Research Review Service Inc., an online, subscription- based service designed to help busy practitioners to integrate current, relevant scientific evidence into |their practice. Shawn graduated from CMCC and holds an Hon- ours Degree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medi- cal Acupuncture from McMaster University, and is a Certified Active Release Techniques (ART®) Pro- vider. For more information about the Research Review Service, visit www.researchreviewservice.com. ecent evidence-based practice guidelines1 even a Cochrane Collaboration Review3 , a narrative literature review2 , and have indicated that mechanical trac- tion for treatment of low back pain (LBP) with or without sciatica cannot be endorsed. This lack of support is based upon clinical trials that compared traction to a sham treatment, placebo, or other treatments using heterogenous samples of LBP patients. Recent evidence has suggested that matching LBP patients to interventions based on a Clinical Prediction Rule (or CPR) which incorporates historical and physical examination factors can improve outcomes, and hence improve the power of clinical research. Most research conducted on traction has not utilized such an approach. Expert opinion, and research thus far on the LBP CPR has identified the following defi ning factors as those most likely to identify patients who will benefit from traction: • presence of sciatica • signs of nerve root compression • a positive straight leg raise test • failure to demonstrate centralization on clinical examination The purpose of this study was to determine whether a subgroup of patients could be identifi ed who would respond favourably to mechanical traction. Sixty-four subjects (average age 41.1) with pain and/or numbness extending distal to the buttock, signs or nerve root compression, and Oswestry score ≥ 30% were randomized into one of two treatment groups: 1) Extension Oriented Treatment Approach (EOTA) (n=33) – received exercises and mobilization to promote lumbar extension and centralization of symptoms (nine sessions in six weeks plus home exercise). 2) Traction plus EOTA (n=31) – exact intervention as EOTA group plus mechanical traction using an adjustable table for the fi rst two weeks (three-dimensional ActiveTrac Table, The Saunders Group Inc.) with the patient prone. Traction was performed for 12 minutes (including one minute ramp-up and down) using 40-60% of the patient’s body weight. Outcomes were assessed at baseline, and at two and six weeks, and included: pain intensity on an eleven-point Numeric Pain Rating Scale, Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire (FABQ), and a fi fteen-point Global Rating of Change Questionnaire. PERTINENT RESULTS OF THIS STUDY INCLUDE: • the traction group displayed greater improvements in disability (mean adjusted ODI difference of 7.2 points) and fear-avoidance (mean adjusted FABQ difference 2.6 points) at two weeks (remember, traction was only utilized for the fi rst two weeks) • there were no between-group differences as six weeks (using intent-to-treat analysis) Continued on Page 26 14 • CANADIAN CHIROPRACTOR |FEBRUARY 2008 www.canadianchiropractor.ca Shawn Thistle, BKin (Hons), DC, CSCS
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