Hidalgo, Benjamin
[UCL]
This thesis on the study of the efficacy of orthopaedic manual therapy (OMT) for patients with nonspecific low back pain (LBP) was developed by following the steps of an evidence-based practice process through three major sections. The Introduction defines the debilitating disorder of LBP and OMT, and describes an integrative approach for the stratification of care in LBP patients. Section 1 presents a systematic review that updates the best evidence of OMT efficacy in terms of pain, functions, activities and participation. The findings allow us: (I) to establish different levels of evidence for this form of therapy, (II) to understand the complexity of LBP and (III) to affirm the importance of the study design quality in OMT trials (e.g. splitting design, complexity of the placebo procedure and integration of clinical reasoning). Section 2, which is composed of three studies, investigates a kinematic model of the spine to help in the diagnosis of LBP patients, as well as outcome measures for future investigations of OMT in LBP patients. This kinematic tool permits a valid assessment of body structures (lumbopelvic and thoracic vertebral column, muscles of the trunk and pelvic regions), body functions (mobility in a vertebral segment, control of complex voluntary movements, proprioceptive function) and activities (bending, maintaining a body position). Finally, Section 3 presents two clinical studies. The first is a reliability study on a standardised and original pain provocation examination of the lumbar spine in a combined movement fashion. This examination provides the direction and vertebral level(s) of treatment. On the basis of this reliable objective examination and evidence described throughout this thesis, a randomised controlled trial was conducted. This last study questions the short-term efficacy of a novel form of OMT, namely mobilisation with movement, on primary kinematic outcome measures (kinematic algorithms for range of motion and speed) and secondary self-reported outcome measures (pain, function, activities and participation) in LBP patients with a mechanical pain pattern in flexion. The results of this investigation raise the overall level of evidence from limited to moderate in favour of using central sustained natural apophyseal glides in LBP patients. In conclusion, the different points and perspectives developed along this thesis contribute towards solving the complex puzzle of LBP within a patient-centred approach. Manual therapy is an art developed through clinical practice, as well as a science developed through fundamental and clinical research. Clinical research is of major importance because it directly drives clinical practice and education towards an evidence-based OMT practice within the biopsychosocial framework, thereby aiding many patients, students and health professionals.


Bibliographic reference |
Hidalgo, Benjamin. Evidence-based orthopaedic manual therapy for patients with nonspecific low back pain : analysis of a kinematic model of the spine. Prom. : Detrembleur, Christine ; Nielens, Henri |
Permanent URL |
http://hdl.handle.net/2078.1/162110 |