#MyPTArticleOfTheMonth – what is Mark Hancock reading?

Mark Hancock is a professor of physiotherapy in the Faculty of Medicine and Health Sciences at Macquarie University in Sydney, Australia. He has over 20 years of clinical experience as a musculoskeletal physiotherapist working in primary care. While he now works primarily as an academic and researcher, Mark manages to fit in some clinical work on a part-time basis. He is one of the founders of the Diagnostic Test Accuracy database (DiTA).

Mark’s clinical practice and research focuses on the diagnosis and management of back pain. Two articles have recently caught his eye.

Huang R, et al. Exercise alone and exercise combined with education both prevent episodes of low back pain and related absenteeism: systematic review and network meta-analysis of randomised controlled trials (RCTs) aimed at preventing back pain. Br J Sports Med 2020;54(13):766-70

This is the first systematic review of prevention interventions for low back pain to use a network meta-analysis approach. Forty randomised controlled trials were included in the analysis. Both exercise alone and exercise combined with education prevented low back pain episodes and low back pain-related work absenteeism compared to standard care. Back belts, shoe insoles, ergonomic adjustment (with or without education or exercise), and education alone were not effective. Mark says: “It is reassuring to see the results of this network meta-analysis are consistent with previous systematic reviews, including the review published by our group (Steffens et al, JAMA Intern Med 2016) finding that exercise and exercise combined with education provide important reductions in the risk of future low back pain. This is an important finding for physiotherapists and suggests we should put more focus on prevention and less on treating low back pain.”

Bråten LCH, et al. Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial. BMJ 2019;367:l5654

This randomised controlled trial compared the effect of antibiotics and placebo on disability for people with chronic low back pain and Type 1 or 2 Modic changes on magnetic resonance images. It aimed to replicate a previous trial that had concluded that antibiotics were highly effective in people with chronic low back pain and Type 1 Modic changes (Albert et al, Eur Spine J 2013). The 2013 trial had attracted an enormous amount of international attention, with some believing it was a major breakthrough in the understanding and treatment of low back pain and others sceptical about the findings. Mark says: “This validation trial has been highly anticipated. The findings are very interesting and require careful interpretation. While the antibiotic intervention was statistically more effective than the placebo, the effect was small and the authors conclude that the intervention does not provide clinically important benefits. This will likely lead to some ongoing controversy.”

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