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Proposing six criteria to improve reproducibility of “usual care” interventions in back pain trials: a systematic review

  • Stephanie C. Pascoe
    Correspondence
    Corresponding author. DSc Post-Graduate Physical Therapy Department, Bellin College, 3201 Eaton Road, Green Bay, WI 54311, USA. Tel.: +1 719 321 9837; fax: +1 920 433 1922.
    Affiliations
    Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA

    Orthopaedic Physical Therapy Residency Program, Evidence in Motion, San Antonio, TX, USA

    Department of Physical Therapy and Integrative Care, Wardenburg Student Health Center, Boulder, CO, USA
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  • Steven L. Spoonemore Jr.
    Affiliations
    Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA

    U.S. Public Health Service, Anchorage, AK, USA
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  • Jodi L. Young
    Affiliations
    Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
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  • Daniel I. Rhon
    Affiliations
    Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA

    Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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      Abstract

      Objectives

      The aim of this study is to determine how usual care is defined in clinical trials for low back pain and the components of care that inform its definition. Six components were proposed and assessed for inclusion: type of practitioner providing care, type of self-management education, addressing physical activity, type of medication, dose of the intervention, and reporting whether care was consistent with current guidelines.

      Study Design and Setting

      Systematic review of clinical trials published between January 1993 and June 2020.

      Results

      One hundred eighty-four studies with 37,989 pooled participants from 11 various settings were included. Only one study provided all six components; 86 (47%) studies provided at least three of six components, the most common being practitioner type, use of self-management education, and addressing physical activity.

      Conclusion

      Most studies had fewer than 50% of the components, limiting reproducibility. There was wide variability in the characterization and number of definition components. Usual care interventions are poorly defined in back pain trials and limit understanding of comparator treatment effect sizes and reproducibility of interventions.

      Graphical abstract

      Keywords

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