Non-specific Mechanisms in Orthodox and CAM management of back pain (MOCAM)

Bradbury, Katherine, Bishop, Felicity, Lewith, George, Yardley, Lucy, Leach, Janine, Roberts, Lisa, MacPherson, Hugh, Dimitrov, Borislav, Eardley, Susan and Greville-Harris, Maddy (2015) Non-specific Mechanisms in Orthodox and CAM management of back pain (MOCAM). European Journal of Integrative Medicine, 7 (6), 682-683. (doi:10.1016/j.eujim.2015.07.013).

Abstract

Introduction: Non-specific effects can have substantial effects on pain and disability. We have designed a major mixed-methods cohort study to investigate and compare non-specific components in physiotherapy, osteopathy, and acupuncture for low back pain (LBP). This project will extend current evidence by identifying the most powerful non-specific components, providing a deeper understanding of the pathways through which they generate positive patient outcomes.

Aims:

• Identify the most powerful non-specific treatment components (largest effect on patient outcomes)

• Compare the magnitude of non-specific effects across orthodox and CAM therapies

• Test which theoretically-derived mechanistic pathways explain their effects

• Compare patient-practitioner interactions across the three therapies

Methods: We will recruit 1548 adults with LBP attending acupuncturists, physiotherapists, and osteopaths in private and NHS clinics. A quantitative longitudinal questionnaire-based study will use multi-level modelling to test hypothesized relationships between non-specific components, key theoretically derived mediators and patient outcomes. A randomised sample of 63 consultations (21 per treatment) will be audio-recorded and analysed using the quantitative Roter Interactional Analysis System and inductive qualitative analysis, to identify treatment-enhancing communication practices.

Conclusions: Evidence suggests that non-specific components are important for patient outcomes across diverse conditions including LBP. The context of CAM therapies may contribute to their effectiveness and CAMs might be particularly good at enhancing non-specific components. To better understand the role of non-specifics in the management of LBP we will study multiple non-specific factors simultaneously, comparing them within different treatments and relating the findings to pain theories, to understand to how they contribute to the consultation.

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Contributors

Author: Katherine Bradbury

Author: Felicity Bishop

Author: Lucy Yardley

Author: Lisa Roberts

Author: Maddy Greville-Harris

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