Response to: “Letter to the Editor entitled: Unjustified extrapolation” [by authors: Supp G., Rosedale R., Werneke M.]

Response to: “Letter to the Editor entitled: Unjustified extrapolation” [by authors: Supp G.,... We would like to thank our colleagues Supp, Rosedale and Werneke for their letter, and the opportunity to respond to the issues theyraise.1‘Data driven’ repeated movement testing?The aim of our paper was not a critique or review of movement based classification systems, as it appears to have been perceived by Supp et al. Rather, the rationale for undertaking this study was based upon the fact that all contemporary movement based classification systems for low back pain (as described by O’Sullivan, Sahrmann, McKenzie, etc.) involve a degree of clinical judgement, i.e. they involve and/or were developed based upon clinical opinion or theoretical models. We would like to re-iterate that data-driven (i.e. non-judgemental) subgrouping involves statistical subgroup derivation, without any reliance upon clinical opinion or underlying theoretical models. The data is allowed to “speak for itself” [1]. As we were not aware of any purely data driven movement based classification systems for people with low back pain, we wanted to examine this possibility. Hence, participants were instructed what specific task to perform, but not given specific instructions on how to perform the movements and they were asked to rate their pain using a numeric pain rating scale.2Methodology of repeated movement testingWe fully acknowledged that the differences observed in pain responses to movement in our study may differ from those of previous studies (i.e. utilising a Mechanical Diagnosis approach) due to differences in our testing procedures and methodology and the two-point cut-off score for pain used for deriving subgroups.3Previous data – acute versus chronic?We wish to highlight that the statement by Supp et al. that we had written, “...prior studies on repeated movements had dealt mainly with non-chronic or exclusively acute patient population[s],” is incorrect. Our specific wording was, “To date, the majority of studies examining pain responses to repeated movements have also involved samples including, or exclusively made up of, people with acute LBP +/- leg pain.” This specific wording serves to highlight that the samples referred to have not been composed entirely of people with chronic axial low back pain, as was the sample in this study.4Extrapolation of results from a cursory repeated movement examination to a comprehensive biopsychosocial system of diagnosis and managementWhen considering this comment in the discussion section we specifically worded it to include all movement-based low back pain classification systems as described in point 1.Our data highlights that pain responses to movement are in part influenced by factors such as psychological distress and pain sensitivity. We are in agreement with Supp et al. that our research protocol is not comparable to the complex interactions involved in any movement-based physical assessment, and do not advocate that it be considered as such. We are also in agreement with Supp et al. that movement-based therapies which include a strong therapeutic alliance, patient education, empowerment, reassurance etc. will likely lead to concurrent improvements in these factors. However, our data suggest that interventions should specifically target multiple dimensions of a person’s clinical presentation, as a potential means of further improving treatment efficacy, rather than focussing on one particular dimension with changes in other dimensions being potential byproducts.Ethical issues: This research was approved by the Human Research Ethics Committees of Curtin University, Royal Perth Hospital, and Sir Charles Gairdner Hospital, Western Australia. All participants gave written, informed consent.Reference[1]Kent P, Keating J, Leboeuf-Yde C. Research methods for subgrouping low back pain. BMC Med Res Methodol 2010;10:62.20598153http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000280800000001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1186/1471-2288-10-62KentPKeatingJLeboeuf-YdeC.Research methods for subgrouping low back painBMC Med Res Methodol20101062 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Scandinavian Journal of Pain de Gruyter

Response to: “Letter to the Editor entitled: Unjustified extrapolation” [by authors: Supp G., Rosedale R., Werneke M.]

Free
1 page

Loading next page...
1 Page
 
/lp/degruyter/response-to-letter-to-the-editor-entitled-unjustified-extrapolation-by-bTJcAyo0rh
Publisher
De Gruyter
Copyright
© 2017 Scandinavian Association for the Study of Pain
ISSN
1877-8860
eISSN
1877-8879
D.O.I.
10.1016/j.sjpain.2017.04.067
Publisher site
See Article on Publisher Site

Abstract

We would like to thank our colleagues Supp, Rosedale and Werneke for their letter, and the opportunity to respond to the issues theyraise.1‘Data driven’ repeated movement testing?The aim of our paper was not a critique or review of movement based classification systems, as it appears to have been perceived by Supp et al. Rather, the rationale for undertaking this study was based upon the fact that all contemporary movement based classification systems for low back pain (as described by O’Sullivan, Sahrmann, McKenzie, etc.) involve a degree of clinical judgement, i.e. they involve and/or were developed based upon clinical opinion or theoretical models. We would like to re-iterate that data-driven (i.e. non-judgemental) subgrouping involves statistical subgroup derivation, without any reliance upon clinical opinion or underlying theoretical models. The data is allowed to “speak for itself” [1]. As we were not aware of any purely data driven movement based classification systems for people with low back pain, we wanted to examine this possibility. Hence, participants were instructed what specific task to perform, but not given specific instructions on how to perform the movements and they were asked to rate their pain using a numeric pain rating scale.2Methodology of repeated movement testingWe fully acknowledged that the differences observed in pain responses to movement in our study may differ from those of previous studies (i.e. utilising a Mechanical Diagnosis approach) due to differences in our testing procedures and methodology and the two-point cut-off score for pain used for deriving subgroups.3Previous data – acute versus chronic?We wish to highlight that the statement by Supp et al. that we had written, “...prior studies on repeated movements had dealt mainly with non-chronic or exclusively acute patient population[s],” is incorrect. Our specific wording was, “To date, the majority of studies examining pain responses to repeated movements have also involved samples including, or exclusively made up of, people with acute LBP +/- leg pain.” This specific wording serves to highlight that the samples referred to have not been composed entirely of people with chronic axial low back pain, as was the sample in this study.4Extrapolation of results from a cursory repeated movement examination to a comprehensive biopsychosocial system of diagnosis and managementWhen considering this comment in the discussion section we specifically worded it to include all movement-based low back pain classification systems as described in point 1.Our data highlights that pain responses to movement are in part influenced by factors such as psychological distress and pain sensitivity. We are in agreement with Supp et al. that our research protocol is not comparable to the complex interactions involved in any movement-based physical assessment, and do not advocate that it be considered as such. We are also in agreement with Supp et al. that movement-based therapies which include a strong therapeutic alliance, patient education, empowerment, reassurance etc. will likely lead to concurrent improvements in these factors. However, our data suggest that interventions should specifically target multiple dimensions of a person’s clinical presentation, as a potential means of further improving treatment efficacy, rather than focussing on one particular dimension with changes in other dimensions being potential byproducts.Ethical issues: This research was approved by the Human Research Ethics Committees of Curtin University, Royal Perth Hospital, and Sir Charles Gairdner Hospital, Western Australia. All participants gave written, informed consent.Reference[1]Kent P, Keating J, Leboeuf-Yde C. Research methods for subgrouping low back pain. BMC Med Res Methodol 2010;10:62.20598153http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000280800000001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f310.1186/1471-2288-10-62KentPKeatingJLeboeuf-YdeC.Research methods for subgrouping low back painBMC Med Res Methodol20101062

Journal

Scandinavian Journal of Painde Gruyter

Published: Dec 29, 2017

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 12 million articles from more than
10,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Unlimited reading

Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.

Stay up to date

Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.

Organize your research

It’s easy to organize your research with our built-in tools.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

Monthly Plan

  • Read unlimited articles
  • Personalized recommendations
  • No expiration
  • Print 20 pages per month
  • 20% off on PDF purchases
  • Organize your research
  • Get updates on your journals and topic searches

$49/month

Start Free Trial

14-day Free Trial

Best Deal — 39% off

Annual Plan

  • All the features of the Professional Plan, but for 39% off!
  • Billed annually
  • No expiration
  • For the normal price of 10 articles elsewhere, you get one full year of unlimited access to articles.

$588

$360/year

billed annually
Start Free Trial

14-day Free Trial