Background: There is lack of evidence for specific treatment interventions for patients with non-specific chronic low back pain (NSCLBP) despite the substantial amount of Randomised Controlled clinical Trials (RCTs) evaluating treatment outcome for this disorder.
Hypothesis: It has been hypothesised that this vacuum of evidence is caused by the lack of sub-classifying the heterogeneous population of patients with CLBP for outcome research.
Study design: A systematic review (SR).
Methods: A systematic review with a meta-analysis (MA) was undertaken to determine the integration of sub-classification strategies with matched interventions in RCTs evaluating manual therapy treatment and exercise therapy for NSCLBP. A structured search for relevant studies in Embase, Cinahl, Medline, PEDro and the Cochrane Trials Register database, followed by hand searching all relevant studies in English up till December 2008.
Results: Only 5 out of 68 studies (7.4%) sub-classified patients beyond applying general in- and exclusion criteria. In the few studies where classification and matched interventions have been utilised, our meta-analysis showed a statistical difference in favour of the classification based intervention for reductions in pain (p= 0.004) and disability (p= 0.0005), both for short and long-term reduction in pain (p= 0.001). Effect sizes ranged from moderate (0.43) short term, to minimal (0.14) for long-term.
Conclusion: A better integration of sub-classification strategies in NSCLBP outcome research is needed. We propose the development of explicit recommendations for the use of sub-classification strategies and evaluation of targeted interventions in future research evaluating NSCLBP.