A randomized controlled trial on the effectiveness of a classification-based system for subacute and chronic low back pain

A.T. Apeldoorn, R.W.J.G. Ostelo, H. van Helvoirt, J.M. Fritz, D.L. Knol, M.W. van Tulder, H.C.W. de Vet

Research output: Contribution to journalArticleAcademicpeer-review

62 Citations (Scopus)


STUDY DESIGN: A randomized controlled trial.

OBJECTIVE: To assess the effectiveness of Delitto's classification-based treatment approach compared with usual physical therapy care in patients with subacute or chronic low back pain.

SUMMARY OF BACKGROUND DATA: No trial has evaluated this approach in patients with subacute and chronic low back pain.

METHODS: Before randomization, all patients were classified by research physical therapists according to a modified version of Delitto's classification-based system. Randomization was computer-generated, with centralized allocation concealment. The statistician and the physical therapists were unblinded. Patients and assistants who collected follow-up questionnaires were blinded. Follow-up assessments were completed at 8, 26, and 52 weeks. The primary analysis was performed according to the intention-to-treat principle, using multilevel analysis. The main outcomes were global perceived effect, disability (Oswestry Disability Index, 0-100), and pain intensity (Numerical Rating Scale, 0-10). Secondary outcomes were quality of life, fear-avoidance beliefs, and psychosocial status. RESULTS.: A total of 156 patients were included (classification-based group, n = 74; usual physical therapy group, n = 82). There were no statistically significant differences between the treatment groups for any of the outcomes at any of the follow-up time points. After 8 weeks, patients in the classification-based group had greater global perceived effect scores; adjusted odds ratio of 1.01 (95% confidence interval [CI], 0.31 to 3.28), and higher adjusted Oswestry Disability Index and Numerical Rating Scale scores; mean adjusted differences of 0.48 points (95% CI, -4.59 to 3.63) and 0.49 points (95% CI, -1.34 to 0.37) respectively, but all differences were statistically nonsignificant.

CONCLUSION: The classification-based system used in this study was not effective for improving physical therapy care outcomes in a population of patients with subacute and chronic low back pain.

Original languageEnglish
Pages (from-to)1347-1356
Number of pages10
Issue number16
Publication statusPublished - 2012


  • Adult
  • Algorithms
  • Chronic Pain
  • Comparative Study
  • Decision Support Techniques
  • Disability Evaluation
  • Fear
  • Female
  • Humans
  • Journal Article
  • Linear Models
  • Low Back Pain
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Netherlands
  • Odds Ratio
  • Pain Measurement
  • Patient Selection
  • Physical Examination
  • Physical Therapy Modalities
  • Predictive Value of Tests
  • Quality of Life
  • Randomized Controlled Trial
  • Recovery of Function
  • Research Support, Non-U.S. Gov't
  • Return to Work
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome

Cite this