How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data.

<h4>Purpose</h4>Individualised physiotherapy is an effective treatment for low back pain. We sought to determine how this treatment works by using randomised controlled trial data to develop a Bayesian Network model.<h4>Methods</h4>300 randomised controlled trial participants...

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Autores principales:	Bernard X W Liew, Jon J Ford, Marco Scutari, Andrew J Hahne
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/c792707f1cbc4ceb8ff7c4bda77bb944
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spelling	oai:doaj.org-article:c792707f1cbc4ceb8ff7c4bda77bb9442021-12-02T20:17:04ZHow does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data.1932-620310.1371/journal.pone.0258515https://doaj.org/article/c792707f1cbc4ceb8ff7c4bda77bb9442021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0258515https://doaj.org/toc/1932-6203<h4>Purpose</h4>Individualised physiotherapy is an effective treatment for low back pain. We sought to determine how this treatment works by using randomised controlled trial data to develop a Bayesian Network model.<h4>Methods</h4>300 randomised controlled trial participants (153 male, 147 female, mean age 44.1) with low back pain (of duration 6-26 weeks) received either individualised physiotherapy or advice. Variables with potential to explain how individualised physiotherapy works were included in a multivariate Bayesian Network model. Modelling incorporated the intervention period (0-10 weeks after study commencement-"early" changes) and the follow-up period (10-52 weeks after study commencement-"late" changes). Sequences of variables in the Bayesian Network showed the most common direct and indirect recovery pathways followed by participants with low back pain receiving individualised physiotherapy versus advice.<h4>Results</h4>Individualised physiotherapy directly reduced early disability in people with low back pain. Individualised physiotherapy exerted indirect effects on pain intensity, recovery expectations, sleep, fear, anxiety, and depression via its ability to facilitate early improvement in disability. Early improvement in disability, led to an early reduction in depression both directly and via more complex pathways involving fear, recovery expectations, anxiety, and pain intensity. Individualised physiotherapy had its greatest influence on early change variables (during the intervention period).<h4>Conclusion</h4>Individualised physiotherapy for low back pain appears to work predominately by facilitating an early reduction in disability, which in turn leads to improvements in other biopsychosocial outcomes. The current study cannot rule out that unmeasured mechanisms (such as tissue healing or reduced inflammation) may mediate the relationship between individualised physiotherapy treatment and improvement in disability. Further data-driven analyses involving a broad range of plausible biopsychosocial variables are recommended to fully understand how treatments work for people with low back pain.<h4>Trials registration</h4>ACTRN12609000834257.Bernard X W LiewJon J FordMarco ScutariAndrew J HahnePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10, p e0258515 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Bernard X W Liew Jon J Ford Marco Scutari Andrew J Hahne How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data.
description	<h4>Purpose</h4>Individualised physiotherapy is an effective treatment for low back pain. We sought to determine how this treatment works by using randomised controlled trial data to develop a Bayesian Network model.<h4>Methods</h4>300 randomised controlled trial participants (153 male, 147 female, mean age 44.1) with low back pain (of duration 6-26 weeks) received either individualised physiotherapy or advice. Variables with potential to explain how individualised physiotherapy works were included in a multivariate Bayesian Network model. Modelling incorporated the intervention period (0-10 weeks after study commencement-"early" changes) and the follow-up period (10-52 weeks after study commencement-"late" changes). Sequences of variables in the Bayesian Network showed the most common direct and indirect recovery pathways followed by participants with low back pain receiving individualised physiotherapy versus advice.<h4>Results</h4>Individualised physiotherapy directly reduced early disability in people with low back pain. Individualised physiotherapy exerted indirect effects on pain intensity, recovery expectations, sleep, fear, anxiety, and depression via its ability to facilitate early improvement in disability. Early improvement in disability, led to an early reduction in depression both directly and via more complex pathways involving fear, recovery expectations, anxiety, and pain intensity. Individualised physiotherapy had its greatest influence on early change variables (during the intervention period).<h4>Conclusion</h4>Individualised physiotherapy for low back pain appears to work predominately by facilitating an early reduction in disability, which in turn leads to improvements in other biopsychosocial outcomes. The current study cannot rule out that unmeasured mechanisms (such as tissue healing or reduced inflammation) may mediate the relationship between individualised physiotherapy treatment and improvement in disability. Further data-driven analyses involving a broad range of plausible biopsychosocial variables are recommended to fully understand how treatments work for people with low back pain.<h4>Trials registration</h4>ACTRN12609000834257.
format	article
author	Bernard X W Liew Jon J Ford Marco Scutari Andrew J Hahne
author_facet	Bernard X W Liew Jon J Ford Marco Scutari Andrew J Hahne
author_sort	Bernard X W Liew
title	How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data.
title_short	How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data.
title_full	How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data.
title_fullStr	How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data.
title_full_unstemmed	How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data.
title_sort	how does individualised physiotherapy work for people with low back pain? a bayesian network analysis using randomised controlled trial data.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/c792707f1cbc4ceb8ff7c4bda77bb944
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How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data.

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