Anne Moseley talked to Professor Sandra Beurskens (Zuyd University of Applied Sciences and Maastricht University, Netherlands) and Professor Riekie de Vet (VU University Medical Center, Netherlands) whose trial evaluating traction for low back pain is one of the 15 most significant trials in physiotherapy.
Anne: Could you explain what you did in the study
Sandra and Riekie: We compared traction to sham traction in people with low back pain (n=151). Two different doses of traction were used – 35-50% (high dose) and less than 20% (low dose or sham) of the patient’s body weight using a split table. The patients and assessors were blinded for the assigned treatment. It was quite a challenge to develop the sham traction, but we thought this was a very important aspect of the study. Comparing traction to a sham (or placebo) increased the rigor of the study. The sham traction involved the patient wearing a special brace around the iliac crest. The patients were told that they only had to feel a little pulling from the brace while receiving a very small amount of traction (less than 20% of body weight). The brace became tighter in the back during treatment. This was experienced as if traction were exerted.
Anne: What was the main finding?
Sandra and Riekie: There was no difference between the traction and sham groups for any of the outcome measures. We used a number of outcome measures. The main outcome was the global impression of perceived effect and the Patient Specific Complaint scale (which is comparable to the Patient Specific Complaints scale). Other outcomes included pain, range of motion and disability. Our data did not support the claim that traction is effective for patients with low back pain.
Anne: Why do you think your study is important?
Sandra and Riekie: We set the trial up in the early 1990’s. At that time traction was a commonly used treatment for low back pain. Traction is a very passive treatment for the patient. Earlier trials on traction did not allow clear conclusions due to methodological flaws. We wanted to work out if it was worthwhile.
Anne: What lead you to do the study?
Sandra and Riekie: When we were setting up the trial it was a commonly held belief that it was not possible to use a randomised controlled trial to evaluate physiotherapy intervention because treatment was so tailored to individual patients. We wanted to conduct a robust randomised controlled trial because it was important for the profession to start rigorously evaluating physiotherapy treatments. We succeeded in performing a high quality trial that was published in The Lancet.
Anne: What studies are you conducting now?
Sandra: This was the only study I conducted on traction for low back pain. Other trails were about mental practice and mirror therapy. At present my work focuses on goal orientated measurement in daily practice, in musculoskeletal and other health areas, for physiotherapists and interdisciplinary (occupational therapy, nurses, speech therapists and physicians). A component of my work is the implementation of outcome measurement in clinical practice.
Riekie: I went on to be involved in a number of studies evaluating the effects of a number of physiotherapy interventions, including laser, graded activity and high-intensity interventions for low back pain as well as other musculoskeletal conditions (for example, neck or shoulder pain). Outcome measurement is also a focus of my current research.
Anne: Sandra and Riekie, thank you for making such a valuable contribution to physiotherapy.