Research Study; “Clinical guidelines for indentifying those who benefit most from Pilates training”.

There aren’t too many clinical research studies on Pilates training.  Below please see a clinical study conducted by a Lise Stolze MPT, MSc, doctoral student in orthopaedics at Rocky Mountain University of Health Professions, Colorado.  Conducted with guidance of Brent Anderson PT, PhD, OCS, President, Polestar Pilates Physical Therapy and Polestar Pilates education.

“Research study showing clinical guidelines for identifying those clients who will benefit most from a Pilates program by one of Polestar’s senior Educators”
by Lise Stolze, Published in JOSPT in 2012.

Background:
Pilates-based exercise has been shown to be effective for patients with LBP, however no work has previously been done to characterize patient attributes for those most likely to have a successful outcome from treatment.
Methods:
Ninety six individuals with non-specific low back pain participated in the study. Treatment response
was categorized based on changes in the Oswestry Disability Questionnaire (ODQ) scores after 8 weeks.
An improvement of 50% or greater was categorized as achieving a successful outcome. Thirty seven variables measured at baseline were analyzed with univariate and multivariate methods to derive
a clinical prediction rule for successful outcome with Pilates exercise.  Accuracy statistics, Receiver Operator Curves (ROC), and regression analyses were used to determine the association between standardized examination variables and treatment response status.
Results:
Ninety five of the 96 participants completed the study, with 51 (53.7%) achieving a successful outcome.  A  preliminary clinical prediction rule with 5 variables was identified: total trunk
flexion ROM of 70 degrees or less, duration of current symptoms of 6 months or less, no leg symptoms in the last week, body mass Index (BMI) of 25 or greater, and left or right hip average rotation of
25 degrees or greater. If 53 or more of the 5 attributes were present (positive likelihood ratio 10.64), the probability of experiencing a successful outcome increased from 54% to 93%.
Conclusion:
These data provide preliminary evidence to suggest that the response to Pilates -based exercise in patients with LBP can be predicted from variables collected from the clinical examination.
If subsequently validated in a randomized clinical trial, this prediction rule may be useful to improve clinical decision-making in determining which patients are most likely to benefit from Pilates-based exercise.
Clinical prediction rules (CPRs) consist of combinations of variables obtained from self-report measures and the historical and clinical examinations. One purpose is to assist with subgrouping patients into specific treatment-based classifications.  Recently, CPRs have been shown to be useful in classifying patients with low back pain (LBP) who are likely to benefit from a particular treatment approach such as spine manipulation and lumbar stabilization. 16, 26, 35
Because CPRs are designed to improve decision-making, it is important they be developed and validated according to rigorous methodological standards.  Once a CPR has been derived, validated,

and shown to positively impact clinical behavior, it can be helpful in selecting the most effective treatment for an individual patient.
We hypothesized that a parsimonious set of factors would emerge from the clinical examination to identify patients with LBP mostly likely to benefit from the Pilates-based exercise.
Pilates-based exercise has gained popular ity as an option for the conservative management of LBP but the evidence for its effectiveness is sparse and inconclusive.44
Lim et al 44 concluded that the relatively low quality of existing studies and the heterogeneity of studies they reviewed suggest that results should be interpreted with caution. However, the few studies that have examined homogenous subgroups of patients with specific exercise
programs have been promising.35, 42, 58
Hicks et al35 established a preliminary clinical prediction rule for success with stabilization exercises.
The purpose of our study was to derive a preliminary CPR for identifying a sub-group of patients with LBP likely to benefit from the Pilates-based exercise.
In this study, the 54% pretest probability of success shifted to 96% with a positive LR of 23.37 if a subject exhibited 4 or more of the 5 criteria in the preliminary prediction rule, and to 93% with a positive LR of 10.64 if a subject exhibited 3 or more of the 5 criteria in the CPR. However, the 4+ level
of the CPR was so specific that a relatively small percentage of subjects in the study (14%) met that criterion. For this reason, we selected the 3+ level as a clinically sensible threshold because 42% of subjects presented with 3 or more tests positive.  If this CPR can be validated with a randomized controlled trial, recommending the 3+ level anticipates that this rule may help suggest appropriate treatment for about 40% of patients presenting for treatment who are similar to subjects in this study.
Pilates-based exercise as a viable treatment option for patients with LBP. 4, 44, 65
Predictor Variables:
This CPR includes 5 predictor variables that would require minimal time to assess as part of a comprehensive patient evaluation.  1) BMI is a value calculated based on height and weight measur
ements and is significantly correlated with body fat content.54 A BMI of equal to or greater than
25 is considered overweight and was a strong predictor of success (p < .001) for subjects in this study. Research has demonstrated that high BMI has a strong association with LBP, 34, 67 and that being very overweight can change static and dynamic spine mechanics, including increased anterior pelvic tilt and limited thoracic flexion during forward bend activities 75.  Both of these mechanical changes could adversely affect the stresses placed on the lumbar spine.
2) Another predictor for success was total trunk flexion ROM less than or equal to 70 degrees.
3) Evidence exists for a relationship between hip joint flexibility and LBP.17, 25  Hipjoint ROM discrepancy was a variable in the preliminary CPR developed for spinan our study, subjects who had

a mean internal and external hip rotation of less than or equal to 25 degrees in either hip tended not to be successful with treatment. Restricted hip rotation ROM has been established as a clinical indicator of hip osteoarthritis 2, 40 and may complicate the treatment of LBP in those with this comorbidity. This is consistent with studies demonstrating that up to 40% of patients with leg pain who are treated conservatively undergo delayed surgery.
4) Symptom duration of less than or equal to 6 months was a predictor of treatment success even though 72% of all subjects in this study reported having symptoms for more than 6 months. Duration of symptoms for more than 12 weeks may be classified as chronic LBP 10
CONCLUSION
Five predictors collected from the clinical examination comprised a clinically sensible preliminary CPR to identify individuals with LBP who are likely to respond to treatment using Pilates–based exercise: total trunk flexion ROM of 70 degrees or less, duration of current symptoms of 6 months or less, no leg symptoms in the previous week, BMI of 25 or greater, and left or right hip average rotation 25 degrees or greater. If any 3 or more of the 5 attributes were present (which occurred in 42% of study subjects), the positive LR was 10.64: sufficient to yield a large shift from pre-test to post-test probability for experiencing a successful treatment outcome.
KEY POINTS
Findings A preliminary CPR with 5 variables was identified: total trunk flexion ROM <70
degrees, duration of current symptoms <6 months, no leg symptoms in the previous week, BMI >
25, and left or right hip average rotation >25 degrees.   If 3 or more attributes were present (positive likelihood ratio10.64), the probability of experiencing a successful outcome increased from 54% to 93%.
Implications
   These data provide preliminary evidence to support the idea that the response to Pilates-based exercise in patients with LBP can be predicted from variables collected from the clinical examination.
Key Words:  classification, Pilates-based exercise, low back pain
The complete research article can be found at the address below:

http://polestarpilates.com/pdf/JOSPT_website_Stolze_LBP%20CPR_2012.pdf

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