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Table 2 Components of each treatment protocol used in the trial

From: Specific treatment of problems of the spine (STOPS): design of a randomised controlled trial comparing specific physiotherapy versus advice for people with subacute low back disorders

Treatment component

DHR

NRDP

RDP

ZJD

MFP

Advice

Patho-anatomical/physiological explanation including generally favourable prognosis

X

Advice in accordance with Indahl et al. [35]

X

X

X

X

X

Explanation of pain physiology and central sensitisation for ongoing pain with multiple biopsychosocial contributing factors

O

O

O

O

X

Discussion of treatment options available

X

Discussion of timeframes and expectations

X

Posture education including lifting technique

O

X

X

Teaching pacing and graded exposure strategies

O

X

Goal setting (establishment and regular reviews)

X

Specific motor control training (transversus abdominis, lumbar multifidus and pelvic floor)

O

X

Teaching and supervision of functional restoration exercises in the clinic with additional sessions at home

X

X

X

Demonstration of functional restoration exercises for implementation at home

X

X

X

X

Education regarding pain management strategies (pharmacological)

O

O

O

O

O

X

Education regarding pain management strategies (non-pharmacological)

O

O

O

O

O

X

Strategies to control inflammation

O

O

O

O

O

X

Application of strapping tape to lumbar spine

O

X

X

Discussion of strategies to manage work issues

O

O

O

O

O

X

Directional preference management (McKenzie program)...includes mechanical loading strategies, repeated movements, walking program, taping, and postural advice

O

O

X

X

X

Manual therapy

X

X

X

X

X

Relaxation strategies

O

O

O

O

O

X

Sleep strategies

O

O

O

O

O

X

Management of increases in pain

O

O

O

O

X

X

Explanation of improvement in function V's improvement in pain

O

O

O

O

X

X

Cognitive restructuring of counterproductive beliefs (via use of information sheets relating to the above treatment components)

X

Behavioural strategies to support and reinforce the education and information provided and to modify unproductive behaviours

X

Transfer to MFP protocol if inadequate progress with pathoanatomical approach after five sessions

O

O

O

O

X

X

Targeted cognitive restructuring and behavioural modification based on review of the Orebro Musculoskeletal Pain Questionnaire subscales

X

X

X

X

X

Specific discussion of psychosocial barriers as an explanation for failure to recover

O

O

O

O

X

Discharge planning for long-term management

X

  1. ✔ = component mandatory, O = component optional/if required, X = component not allowed, DHR = disc herniation with associated radiculopathy, NRDP = non-reducible discogenic pain, RDP = reducible discogenic pain, ZJD = zygapophyseal joint dysfunction, MFP = multi-factorial persistent pain