Does Clinical Research Fulfil the Treatment Parameters Used by Clinicians?

PURPOSE: Traditionally in assessing the quality of research, methodological rigour alone has been examined. However the efficacy of the intervention itself is important as inadequacies in these areas may lead to substantial bias and may result in a lack of acceptance (and implementation) of the results by clinicians. This paper will look at what are the recommended treatment parameters that should be used in research on the efficacy of traction for LBP and discuss whether these criteria have been met in previous research trials. RELEVANCE: Consensus as to the management and treatment of LBP is still under debate and the efficacy of many physiotherapeutic interventions remains unclear. Lumbar traction continues to be used as a treatment but the research is inconclusive due to poor methodological quality. Treatment parameters need to be identified so that future studies will reflect clinical practice. SUBJECTS: Not applicable. METHODS AND MATERIALS: A computerised search using key words and a hand search of relevant manual therapy texts was undertaken. The application of optimal treatment weights, the length of the treatment session, the frequency of treatment, and the length of the overall programme of traction are areas that have had limited research. Therefore the determination of optimal treatment parameters were drawn from recommendations from expert opinion, supplemented by limited evidence on the mechanical and physiological effects of traction. ANALYSIS: Parameters were combined. RESULTS: Traction weights must be in excess of 26% of body weight or use a friction free couch, in addition to this a weight ranging from 10-85 kgs is required. Treatment times (at each session) ranged from 10-45 mins, expert opinion suggested that acute nerve root problems received daily treatment for at least two weeks and chronic problems received treatment 2-3 times weekly for a minimum of three weeks. On applying these criteria to RCTs looking at the efficacy of lumbar traction only four trials (total 13) met these criteria. CONCLUSION: This paper highlights the problems associated with establishing appropriate clinical parameters for research in lumbar traction, and also the effects of applying these criteria to the available research base. It is essential that these parameters are clarified if a high quality trial is to be designed; a solution to this is to survey clinicians about how and why they use lumbar traction.