Introduction
Back pain can be described as the pain that is felt in back and which may originate “from joints, nerves, muscles or other structures in the spine” (Assendelft 17, pp. 4). In most cases, back pain is felt at the lower half of the back and is thus referred to as lower back pain (LBP) (Bogduk 82). Lower back pain is a very common condition; studies indicate that up to 80% of individuals can suffer from lower back pain at one point of the life (Schade 1893).
LBP is a common cause of job related disability and the second most common neurological ailment (French 36). Several studies have been done in regard to the onset, diagnosis and treatment of lower back pain (Assendelft 19). Most have reported wide ranging causes and proposed a variety of treatment plans. This paper seeks to critically analyze a research study report that sought to investigate the effects of sizes of treatments for non-specific LBP in randomized controlled studies comparing treatment with no treatment (Hayden and Tulder 1778).
Summary of the report
Many randomized trial studies have been carried out to investigate the effectiveness of treatments for non-specific low-back pain (Hayden and Tulder 1779). These studies have either compared treatment interventions with no treatment groups or comparing different sets of interventions. No differences are observed in studies that compare two interventions raising the question as to whether the interventions are effective. In order to establish the effectiveness of the various interventions, randomized controlled trials were from systemic reviews were searched in the 2nd issue of the Cochrane Library in 2005 and other available databases (Hayden and Tulder 1781).
The data that was extracted to measure the effect sizes was estimated as Standardized Mean Differences (SMD) and Relative Risk (RR) or data enabling the calculation effect sizes (Hayden and Tulder 1784). As for acute instances of LBP, the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDSs) was remote and exercise had no impact (Hayden and Tulder 1784). For chronic lower back pain, behavioral therapy, NSAIDSs, acupuncture and exercise therapy had the most usability but with limited therapeutic effect. All other intervention measures for chronic lower back pain such as trans-cutaneous electric nerve stimulation and manipulation had limited effect (Hayden ad Tulder 1785).
The study concluded that the effectiveness of the current treatments measures for lower back pain is small to moderate. Therefore, there is a need for developing more effective treatment strategies to tackle lower back pain (Hayden and Tulder 1786).
Analysis of Strengths
The study utilized scientific methodology to compare research data from various studies in order to determine the effectiveness of various intervention plans for treating lower back pain. Even though the study focused on an area that has several non-specific data that makes it difficult to draw comparisons, it was able mine through and get some consistent data that was used to arrive at the conclusions. It was wise to use the standardized mean difference (SMD) to estimate the treatment effect of the individual trials for similar constructs (Hayden and Tulder 1783). This allowed direct comparisons to be made for studies that had utilized different measures that have identical constructs.
The study also employed scientific analysis for effect sizes to classify the interventions as effective, non effective, limited effect among others. In this case the Cohen effect size approach was utilized (Grimmer 487). The study results this study indicates that the current intervention strategies for lower back pain (both acute and chronic) have done little or failed to offer relief to patients suffering from the condition. The study thus proposes the identification of new intervention measures that will adequately treat lower back pain. Although the findings are not that clear, they are nevertheless important as they prompt for more research into a common but neglected area of medicine (King 56).
Analysis of weaknesses and the recommendations
The study used a relatively small pool of data to draw their conclusions, the authors agree that only a few studies of all included in the Cochrane Library had the correct data. The study was concentrated on one issue of the Cochrane library possibly neglecting other vast data that might have impacted on the findings (Urquhart 1756). The studies used had no follow up data on the identified cases of acute and chronic lower back pain. This puts in doubt the validity of the results, bearing in mind that some interventions such as exercise and behavioral measures were intended for long-term benefit and therefore their effectiveness can only be verified using follow up data.
The research also utilized some scientific measures without being sure of their relevance in the current case (Schade 1892). For instance the study used categorized effect sizes according to the Cohen values but did not reveal how that applies to the low back pain data which is prone to many assumptions due to lack of specific data. The research data was also compounded with a lot of non specific measures leading to many assumptions. This might have compromised the quality of the findings. In my view the study could have incorporated the diagnosis aspect to determine in order to effectively determine which intervention was working or not working for a specific type of back pain categorized by the cause (Middelkoomp 195).
The authors sought to establish the effectiveness of the intervention measures and so they only compared data from treatment with non-treatment groups. They should have included data showing comparisons between the different interventions. Some of the studies had no variance data and so therefore the authors resorted to using the percentages of pooled standard deviation to make up for the missing data (Hayden and Tulder 1787). This was a risk move that could have impacted on the final results of this study.
Due to various assumptions and use of limited data, the study did not identify any effective intervention for acute or chronic lower back pain. The study showed that there was modest effectiveness, if any, for short term pain relief (Rubinstein & Verhagen 24). The NSAID had a modest relief from acute back pain and exercise had no effect at all. The study relied so much on the classification of the back as acute or chronic which was a mistake.
The results could have been more accurate if the study could have analyzed the intervention measure in relation to the cause of the back pain. In the conclusion, the authors fall short of declaring that all the current intervention strategies for lower back pain as failed treatment strategies (Urquhart 1987). They propose the development of new treatment strategies to tackle back pain. This is a good way to go due to the observed general failure of most of these strategies. However, the authors should have provided the direction in which new research should follow to establish this new intervention measures. The study results could have been better if the underlying causes were established.
This problem is not limited to the current authors alone, even the studies utilized gave little attention to the underlying causes. Furthermore, many cases of lower back pain are often treated without determining the underlying cause. Only certain cases that appear to be serious are investigated further through diagnostic imaging. Thus the first step towards the development of effective intervention measures is to a diagnosis focused treatment strategy in the field of lower back pain. That way, it will be easy to identify the interventions that are working or not working for a particular case of lower back pain (LBP) depending on the underlying cause (King 78).
Conclusion
This paper sought to critically analyze a research study report that sought to investigate the effects of sizes of treatments for non-specific LBP in randomized controlled studies comparing treatment with no treatment (Hayden and Tulder 1780). The analysis has established that the study had some positive contributions that should be used as a basis to prompt for development of new intervention measures to tackle the problem of lower back pain. The study had some limitations also, especially in regard to the quality and quantity of data that was used, and the scope of the study which might have slightly compromised the results. It however had an overall positive impact for prompting further research in a largely neglected area.
Works Cited
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