This trial represents a new and promising approach for the physiotherapy management of low back pain in primary care. By using a previously validated and simple-to-use prognostic screening tool developed in a primary care physician setting, Hill and colleagues found that a stratified management approach, in which prognostic screening and treatment targeting were combined, resulted in improved primary care efficiency of physiotherapy. The potential for targeting treatment has been emphasised as a research priority (Borkin and Cherkin 1996, Bouter et al 1998). The study is well-conducted, powered to detect differences between subgroups, and satisfies the recommendations
for studying subgroups of responders to physiotherapy interventions (Hancock Integrase inhibitor et al 2009). The results are consistent and in favour of the intervention group across most outcome variables, included cost-effectiveness
analysis. It should however be noted that the difference between groups in the main outcome variable (Roland Morris Disability Questionnaire) reached the pre-specified level of 2.5 only at one time point (2.5 (95% CI 0.9 to 4.2) in the high-risk group at 4 months follow-up) and ranged from 0.1 (95% CI −1.1 to 1.4) to 2.0 (95% CI 0.8 to 3.2) for all other comparisons. This effect is similar to other primary care trials. Further, drop-out was substantial (almost 25% drop-out at 12 months follow-up) and a co-intervention high throughput screening compounds consisting of a 15 minute educational video and the Back Book given all participants in the intervention group may have influenced the results of the prognostic screening and targeted treatment. The study is however much needed and shows that physiotherapy management of low back pain can be improved. The promising approach by Hill and colleagues and other recent literature indicating that low back patients are heterogeneous and profit by targeted treatment should be implemented by below physiotherapists and further
developed to find the best treatment strategy for this large and costly patient group. “
“Summary of: Petersen J et al (2011) Preventive effect of eccentric training on acute hamstring injuries in men’s soccer: a cluster-randomized controlled trial. Am J Sports Med 39: 2296–2303. [Prepared by Nicholas Taylor, CAP Co-ordinator.] Question: Does eccentric muscle training of hamstring muscles reduce the rate of hamstring injuries in male soccer players? Design: Cluster randomised, controlled trial with concealed allocation. Setting: The 5 top men’s soccer divisions in Denmark. Participants: First team squad soccer players from teams in the top 5 national soccer divisions were included. Players who joined a team after the start of the trial were excluded. Randomisation of 54 teams allocated 26 to the intervention group and 28 to a control group. Interventions: Both groups followed their usual training program.