Thanks for clarifying that Nick!

Sean – great point regarding the demographics. I’d think that subjects who didn’t seek out treatment on their own due to severity of symptoms or functional limitations are either stubborn older males or may not feel like they really need help. Also, kudos to you for beating Nick.

Oksana – did you find an activity for you patient? I think in that case the specific activity may not be the deciding factors, but maybe addressing his fear. If you can get him to verbalize what exactly his fears are (may seem obvious to us, but might help his though process/understanding) you could then perhaps brain storm with him what he needs to be able to do to surpass those fears and how to get there. Just a thought.

Nick and Laura – fully agree with your comments on chronicity of symptoms and perception of change!

The reason I like the GRoC in this case, is because the objective measures weren’t all too high to begin with, nor did the pts have symptoms/functional limitations severe enough to seek out treatment independently. A lot of times we can see objective improvement in patients with what we test, but how often do you get a patient whose outcome questionnaires/measures test about the same, or even worse? If your answer is not a lot then me may be dealing with vastly different demographics.
The point is we’ll always be able to find some limitations, just like there will always be MRI findings. The patient perceiving their improvement to be significant in regards to overall well being, function, quality of life etc. might then be more important than improved scores on an ODI. Just playing devil’s advocate here.
Given that in this study the outcomes were measured with questionnaires and there was no real objective or functional testing, I’d go with the GRoC in this case.

My problem with this article and several more similar to it, is the design and the almost forced attempt to show that specificity doesn’t make a difference. I’m surprised that Cook has been part of two studies like this in a short amount of time. If there is no differentiation of what the problem is, then I can see why specificity wouldn’t make much of a difference. Unfortunately, there are a lot of studies that don’t look at specifics (that we’d all assess in our objective), but rather group patients by body region and some statistical overlap of demographics, duration of symptoms and outcome measures.

In regards to the chronicity of these subjects, my guess is the improvement they did experience was just because there was some/any kind of input into the neurophysiological/MSK system in addition to adding some form of exercise. Maybe a thoracic PA group + exercise would’ve gotten the same results.