NMSK-S Assignment: Intervention for Low Back Pain & Evaluation

This assignment presents a case study focused on a patient experiencing low back pain, potentially due to lumbar disc herniation. The analysis involves identifying possible hypotheses based on the patient's symptoms, assessing severity and irritability, and suggesting appropriate tests. A key component is the selection and critical evaluation of a physiotherapeutic intervention, specifically exercise, as recommended by NICE guidelines for low back pain management. The assignment also involves reviewing existing research, including systematic reviews and meta-analyses, to support the chosen intervention. The student critically appraises the evidence, considering factors such as study design, sample size, and the applicability of research findings to the patient's specific condition. This document is available on Desklib, offering students access to a wealth of study resources, including solved assignments and past papers.

Appendix
Paper for appraisal- “Improvement of lumbar motor control and trunk muscle conditions with a
novel low back pain prevention exercise program”
CASP Checklist
1) Did the study address
a clearly focused
issue?
No, the title of the study was generic and did not mention
that the research was specifically conducted on ballet women
dancer. The intervention “novel low back pain prevention
exercise program” was also not specific.
2) Did the authors use an
appropriate method to
answer their question?
A case control study was an appropriate way of answering
the question for this research and I believe the study question
was addressed properly.
3) Were the cases
recruited in an
acceptable way?
The participants were defined precisely that is they were
ballet dancers as low back pain is frequent among ballet
dancers. All the participants were representative of that
population. However, the number of participants were low.
4) Were the controls
selected in an
acceptable way?
The controls belonged to the same population group that is
ballet dancers, belonging to the same average age (14.86 ±
1.00 years) as that of the intervention group (14.91 ± 1.37
years). However, the number of participants in this group
was also less which may compromise the generalizability of
the results.
5) Was the exposure
accurately measured to
minimise bias?
The authors used the objective measurements which is one
way of reducing the retrospective biasing. The measures
truly reflected what they are supposed to measure.
6) Aside from the
experimental
intervention, were the
groups treated
equally?
Yes
7) How large was the
treatment effect?
The pain intensity that was examined during training with
visual analog scale, the habitual posture with
photogrammetry, the abdominal muscle strength with Kraus-
Weber test, the static muscle strength of the trunk muscles
with core test and the lumbar motor control with leg
lowering test. I believe the analysis was appropriate for the
design.
8) How precise was the
estimate of the
treatment effect?
In the intervention group the intensity of pain significantly
decreased (VAS1: p = 0.012; VAS2: p = 0.021), the
abdominal muscle strength significantly improved (K-W. B:
p=0.025; K-W. C: p<0.001), the static muscle strength of
trunk muscles significantly increased (Core-test: p<0.001)
and the lumbar motor control significantly improved in both

legs (Leg low. R.: p<0.001; Leg low. L.: p<0.001). Also, the
habitual posture greatly improved (frontal view: 34.78%,
side view: 52.17%).
9) Do you believe the
results?
Yes I believe the results as the research designs and methods
are appropriate make the results reliable.
10) Can the results be
applied to the local
population?
The subjects covered in the study are only ballet dancers and
the sample size is small in number so the it is not sufficiently
same to the general population.
11) Do the results of this
study fit with other
available evidence?
Yes
Paper for appraisal- “A Systematic Review of the Effects of Exercise and Physical Activity on
Non-Specific Chronic Low Back Pain”
1) Did the review address a
clearly focused question?
The review is clearly focused and addresses a direct
question. The focus in terms of intervention studied that
is exercise and physical activity. It is also focused in
terms of the population which is people suffering from
non-specific chronic low back pain. The title of the
article mentions the type of research study that is
systematic review. The mention of the study type in in
the title, makes it easily searchable in the database. The
review question is clearly focused and explanatory and
fulfil its key function of clarifying the aim of the study
for the readers.
2) Did the authors look for
the right type of papers?
The intervention programmes were identified using the
search terms “non-specific chronic low back pain and
exercise” which returned 141 results. Other search terms
included “chronic low back pain and aerobic exercise”

(187 results), “chronic low back pain and muscular
strength” (120 results) and “non-specific chronic low
back pain” (173 results). A total of 14 studies were
included within the final review.
3) Do you think all the
important, relevant studies
were included?
A review of the literature was carried out using the
databases SPORTDiscuss, Medline and Google Scholar.
4) Did the review’s authors
do enough to assess
quality of the included
studies?
The study lack the elaboration of how the quality of the
included studies were assessed.
5) If the results of the review
have been combined, was
it reasonable to do so?
Yes
6) What are the overall
results of the review?
Exercise intervention programmes involving either
muscular strength, flexibility or aerobic fitness is
beneficial for NSCLBP but not acute low back pain.
7) How precise are the
results?
the results of this research study was adequately precise
8) Can the results be applied
to the local population?
The results are not likely to be applicable as the number
of studies included in the review was very less and even
those were included were not assessed for their quality.
9) Were all important I believe that all the significant outcomes were

outcomes considered? considered by the authors.
10) Are the benefits worth the
harms and costs?
Since the study reach a clinically significant outcome, it
can be said that the benefits of conducting the research
may be worth the costs of conducting it. But the
generalizability again remains a factor.
Paper for appraisal- “Prevention of Low Back Pain: A Systematic Review and Meta-
analysis”
1) Did the review address a
clearly focused question?
The title of the review does not addresses a direct
question as it does not focus on the population or
intervention.
2) Did the authors look for
the right type of papers?
Randomized clinical trials of prevention strategies for
nonspecific low back pain.
3) Do you think all the
important, relevant studies
were included?
MEDLINE, EMBASE, Physiotherapy Evidence
Database Scale, and Cochrane Central Register of
Controlled Trials from inception to November 22, 2014.
4) Did the review’s authors
do enough to assess
quality of the included
studies?
Two independent reviewers extracted data and assessed
the risk of bias. The Physiotherapy Evidence Database
Scale was used to evaluate the risk-of-bias. The Grading
of Recommendations Assessment, Development, and
Evaluation system was used to describe the quality of
evidence.
5) If the results of the review Yes

have been combined, was
it reasonable to do so?
6) What are the overall
results of the review?
The literature search identified 6133 potentially eligible
studies; of these, 23 published reports (on 21 different
randomized clinical trials including 30,850 unique
participants) met the inclusion criteria. With results
presented as RRs, there was moderate-quality evidence
that exercise combined with education reduces the risk
of an episode of LBP and low-quality evidence of no
effect on sick leave. Low- to very low-quality evidence
suggested that exercise alone may reduce the risk of
both an LBP episode and use of sick leave. For
education alone, there was moderate- to very low-
quality evidence of no effect on LBP or sick leave.
There was low- to very low-quality evidence
that back belts do not reduce the risk of LBP episodes or
sick leave. There was low-quality evidence of no
protective effect of shoe insoles on LBP.
7) How precise are the
results?
The results of this research study was adequately precise
8) Can the results be applied
to the local population?
The results are likely to be applicable to general
population.
9) Were all important
outcomes considered?
I believe that all the significant outcomes were
considered by the authors.
10) Are the benefits worth the
harms and costs?
Since the study reach a clinically significant outcome, it
can be said that the benefits of conducting the research
may be worth the costs of conducting it. But the
generalizability again remains a factor.
Paper for appraisal- Motor Control Exercise for Nonspecific Low Back Pain: A Cochrane
Review

1) Did the review address a
clearly focused question?
The review is clearly focused and addresses a direct
question.
2) Did the authors look for
the right type of papers?
Yes
3) Do you think all the
important, relevant studies
were included?
Electronic searches of CENTRAL, MEDLINE,
EMBASE, five other databases, and two trials registers
from their inception up to April 2015 were conducted.
4) Did the review’s authors
do enough to assess
quality of the included
studies?
Two independent review authors screened the search
results, assessed risk of bias, and extracted the data. A
third reviewer resolved any disagreement. We assessed
risk of bias using the Cochrane Back and Neck (CBN)
Review Group 12-item criteria. We assessed the overall
quality of the evidence using the GRADE approach.
5) If the results of the review
have been combined, was
it reasonable to do so?
Yes
6) What are the overall
results of the review?
MCE is probably more effective than a minimal
intervention for reducing pain, but probably does not
have an important effect on disability, in patients with
chronic LBP. There was no clinically important
difference between MCE and other forms of exercises
or manual therapy for acute and chronic LBP.
7) How precise are the
results?
the results of this research study was adequately precise
8) Can the results be applied
to the local population?
The results are likely to be applicable.

9) Were all important
outcomes considered?
I believe that all the significant outcomes were
considered by the authors.
10) Are the benefits worth the
harms and costs?
Since the study reach a clinically significant outcome, it
can be said that the benefits of conducting the research
may be worth the costs of conducting it. But the
generalizability again remains a factor.