The Value of Traction in Treatment of Lumbar Radiculopathy - Full Text View

Purpose

The purpose of this study is to determine the effectiveness of adding mechanical traction to standard physical therapy treatments for patients with low back pain.

Condition	Intervention	Phase
Sciatica Radiculopathy Spinal Diseases Musculoskeletal Diseases Neuromuscular Diseases Intervertebral Disk Displacement	Other: Physical therapy rehabilitation	Phase 3


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: Single Blind (Investigator) Primary Purpose: Treatment
Official Title:	The Value of Traction in Treatment of Lumbar Radiculopathy.

Further study details as provided by Julie Fritz, Intermountain Health Care, Inc.:

Primary Outcome Measures:

Oswestry Disability Index [ Time Frame: Baseline, 6 weeks, 6 months, 1year ]

Secondary Outcome Measures:

Global Rating of Change [ Time Frame: Baseline, 6 weeks, 6 months, 1 year ]


Enrollment:	120
Study Start Date:	July 2009
Study Completion Date:	December 2012
Primary Completion Date:	December 2012 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Active Comparator: Extension oriented treatment approach Extension exercises. Subjects are instructed in a progression of extension oriented movements for the lumbar spine. Manual therapy may be added to further increase extension movement and/or reduction of symptoms.	Other: Physical therapy rehabilitation Extension oriented exercises. Subjects will be instructed in a progression of extension oriented exercises for the lumbar spine Other Names: McKenzie exercises Directional preference Specific exercise
Experimental: Mechanical traction plus extension-oriented treatment Mechanical lumbar traction will be utilized in addition to extension oriented exercises. Subjects are also instructed in a progression of extension oriented movements for the lumbar spine. Manual therapy may be added to increase extension movement and/or reduce radicular symptoms.	Other: Physical therapy rehabilitation Mechanical lumbar traction will be applied with subjects in prone utilizing 40-60% of subject's body weight to create a distraction force in the lumbar spine. Following traction, subjects will be instructed in a progression of extension oriented exercises and manual therapy to increase extension as described for the comparator group. Other Name: Saunders 3D Active Trac

Arms

Assigned Interventions

Active Comparator: Extension oriented treatment approach

Extension exercises. Subjects are instructed in a progression of extension oriented movements for the lumbar spine. Manual therapy may be added to further increase extension movement and/or reduction of symptoms.

Other: Physical therapy rehabilitation

Extension oriented exercises. Subjects will be instructed in a progression of extension oriented exercises for the lumbar spine

Other Names:

McKenzie exercises
Directional preference
Specific exercise

Experimental: Mechanical traction plus extension-oriented treatment

Mechanical lumbar traction will be utilized in addition to extension oriented exercises. Subjects are also instructed in a progression of extension oriented movements for the lumbar spine. Manual therapy may be added to increase extension movement and/or reduce radicular symptoms.

Other: Physical therapy rehabilitation

Mechanical lumbar traction will be applied with subjects in prone utilizing 40-60% of subject's body weight to create a distraction force in the lumbar spine. Following traction, subjects will be instructed in a progression of extension oriented exercises and manual therapy to increase extension as described for the comparator group.

Other Name: Saunders 3D Active Trac

Detailed Description:

Despite the opinions of clinical experts that patients who might benefit from traction may represent distinct sub-groups of patients, most studies have not attempted to narrow their inclusion criteria beyond loose definitions of 'acute' or 'chronic' symptoms. While these studies seem to indicate that traction interventions will be of little benefit when administered to large groups of patients without a prior attempt to select which patients are most likely to benefit, they are not sufficient to preclude the possibility that a subgroup of patients may benefit substantially from the intervention. Recent preliminary studies suggest a there exists a subgroup of patients with LBP that is likely to benefit from traction.

The two primary aims of this study are:

Determine the validity of the previously-identified prediction criteria to identify patients highly likely to benefit from the addition of traction to a standard physical therapy intervention.
Compare the overall effectiveness of addition of a traction component to a standard physical therapy intervention.

Eligibility


Ages Eligible for Study:	18 Years to 60 Years (Adult)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Chief complaint of pain and/or paresthesia in the lumbar spine with a distribution of symptoms that has extended distal to the gluteal fold on at least one lower extremity within the past 24 hours based on the patient's self-report.
Oswestry disability score of at least 20%
Age at least 18 years and less than 60 years
At least one of the following signs of nerve root compression:
1. Positive ipsilateral or contralateral straight leg raise test (reproduction of leg symptoms with straight leg raise < 70 degrees)
2. Sensory deficit to pinprick on the ipsilateral lower extremity
3. Diminished strength of a myotome (hip flexion, knee extension, ankle dorsiflexion, great toe extension, or ankle eversion) of the ipsilateral lower extremity
4. Diminished lower extremity reflex (Quadriceps or Achilles) of the symptomatic lower extremity

Exclusion Criteria:

Red flags noted in the patient's general medical screening questionnaire (i.e., tumor, metabolic diseases, RA, osteoporosis, spinal compression fracture, prolonged history of steroid use, etc.)
Evidence of central nervous system involvement, to include symptoms of cauda equina syndrome (i.e., loss of bowel/bladder control or saddle region paresthesia) or the presence of pathological reflexes (i.e., positive Babinski)
Patient reports the complete absence of low back and leg symptoms when seated
Recent surgery (< 6 months) to the lumbar spine or buttocks, or any fusion surgery of the lumbar spine or pelvis
Recent (< 2 weeks) epidural steroid injection for low back and/or leg pain
Current pregnancy
Inability to comply with the treatment schedule

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00942227

Locations


United States, Utah
Intermountain Healthcare, Rehab Agency
Salt Lake City, Utah, United States, 84119

Sponsors and Collaborators

Intermountain Health Care, Inc.

University of Utah

Wilford Hall Medical Center

Empi, A DJO Company

Investigators


Principal Investigator:	Julie M Fritz, PhD	Intermountain Healthcare; University of Utah

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Thackeray A, Fritz JM, Childs JD, Brennan GP. The Effectiveness of Mechanical Traction Among Subgroups of Patients With Low Back Pain and Leg Pain: A Randomized Trial. J Orthop Sports Phys Ther. 2016 Mar;46(3):144-54. doi: 10.2519/jospt.2016.6238. Epub 2016 Jan 26.

Fritz JM, Thackeray A, Childs JD, Brennan GP. A randomized clinical trial of the effectiveness of mechanical traction for sub-groups of patients with low back pain: study methods and rationale. BMC Musculoskelet Disord. 2010 Apr 30;11:81. doi: 10.1186/1471-2474-11-81.


Responsible Party:	Julie Fritz, Clinical Outcomes Research Scientist, Intermountain Health Care, Inc.
ClinicalTrials.gov Identifier:	NCT00942227 History of Changes
Other Study ID Numbers:	1008586
Study First Received:	July 16, 2009
Last Updated:	January 11, 2013

Keywords provided by Julie Fritz, Intermountain Health Care, Inc.:


Sciatica Radiculopathy Physical therapy modalities Rehabilitation

Additional relevant MeSH terms:


Radiculopathy Spinal Diseases Neuromuscular Diseases Sciatica Musculoskeletal Diseases Intervertebral Disc Displacement Peripheral Nervous System Diseases Nervous System Diseases Bone Diseases	Neuralgia Pain Neurologic Manifestations Sciatic Neuropathy Mononeuropathies Signs and Symptoms Hernia Pathological Conditions, Anatomical

ClinicalTrials.gov processed this record on May 25, 2017