Iranian Red Crescent Medical Journal

Published by: Kowsar

The Effectiveness of Classification-Specific Physical Therapy for People with Low Back pain Within Dominant Movement-Based Schemes: A Systematic Review

Sara Zamiri 1 , Mohammad Jafar Shaterzadeh Yazdi 2 , Elham Maraghi 3 and Ismail Ebrahimi Takamjani 4 , *
Authors Information
1 PhD Candidate, Physical Therapy Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, IR Iran
2 Assistant Professor, Department of Physiotherapy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
3 Assistant Professor of Biostatistics, Department of Biostatistics and Epidemiology, School of public health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
4 Professor, Physical Therapy Department, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, IR Iran
Article information
  • Iranian Red Crescent Medical Journal: December 2016, 18 (12); e41959
  • Published Online: December 4, 2016
  • Article Type: Review Article
  • Received: September 13, 2016
  • Revised: October 20, 2016
  • Accepted: November 26, 2016
  • DOI: 10.5812/ircmj.41959

To Cite: Zamiri S, Shaterzadeh Yazdi M J, Maraghi E, Ebrahimi Takamjani I. The Effectiveness of Classification-Specific Physical Therapy for People with Low Back pain Within Dominant Movement-Based Schemes: A Systematic Review, Iran Red Crescent Med J. 2016 ; 18(12):e41959. doi: 10.5812/ircmj.41959.

Copyright © 2016, Iranian Red Crescent Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited
1. Background
2. Objectives
3. Data Sources
4. Study Selection
5. Data Extraction
6. Results
7. Conclusions
  • 1. Kent PM, Keating JL. The epidemiology of low back pain in primary care. Chiropr Osteopat. 2005;13:13. doi: 10.1186/1746-1340-13-13. [PubMed: 16045795].
  • 2. Steenstra IA, Verbeek JH, Heymans MW, Bongers PM. Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature. Occup Environ Med. 2005;62(12):851-60. doi: 10.1136/oem.2004.015842. [PubMed: 16299094].
  • 3. Thelin A, Holmberg S, Thelin N. Functioning in neck and low back pain from a 12-year perspective: a prospective population-based study. J Rehabil Med. 2008;40(7):555-61. doi: 10.2340/16501977-0205. [PubMed: 18758673].
  • 4. Stubbs B, Koyanagi A, Thompson T, Veronese N, Carvalho AF, Solomi M, et al. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries. Gen Hosp Psychiatry. 2016;43:63-70. doi: 10.1016/j.genhosppsych.2016.09.008. [PubMed: 27796261].
  • 5. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8-20. doi: 10.1016/j.spinee.2007.10.005. [PubMed: 18164449].
  • 6. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am. 2006;88 Suppl 2:21-4. doi: 10.2106/JBJS.E.01273. [PubMed: 16595438].
  • 7. Steel N. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1545-602. doi: 10.1016/s0140-6736(16)31678-6.
  • 8. Lin CC, Li Q, Williams CM, Maher CG, Day RO, Hancock MJ, et al. The economic burden of guideline-recommended first line care for acute low back pain. Eur Spine J. 2016. doi: 10.1007/s00586-016-4781-0. [PubMed: 27652679].
  • 9. Yang H, Haldeman S, Lu ML, Baker D. Low Back Pain Prevalence and Related Workplace Psychosocial Risk Factors: A Study Using Data From the 2010 National Health Interview Survey. J Manipulative Physiol Ther. 2016;39(7):459-72. doi: 10.1016/j.jmpt.2016.07.004. [PubMed: 27568831].
  • 10. Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, et al. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3):251-8. doi: 10.1001/archinternmed.2008.543. [PubMed: 19204216].
  • 11. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003;12(2):149-65.
  • 12. Pengel LH, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. BMJ. 2003;327(7410):323. doi: 10.1136/bmj.327.7410.323. [PubMed: 12907487].
  • 13. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163-96. doi: 10.1016/S0140-6736(12)61729-2. [PubMed: 23245607].
  • 14. Borkan JM, Koes B, Reis S, Cherkin DC. A report from the Second International Forum for Primary Care Research on Low Back Pain. Reexamining priorities. Spine (Phila Pa 1976). 1998;23(18):1992-6. [PubMed: 9779533].
  • 15. Brennan GP, Fritz JM, Hunter SJ, Thackeray A, Delitto A, Erhard RE. Identifying subgroups of patients with acute/subacute "nonspecific" low back pain: results of a randomized clinical trial. Spine (Phila Pa 1976). 2006;31(6):623-31. doi: 10.1097/01.brs.0000202807.72292.a8. [PubMed: 16540864].
  • 16. Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Majkowski GR, et al. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med. 2004;141(12):920-8. [PubMed: 15611489].
  • 17. Halliday MH, Ferreira PH, Hancock MJ, Clare HA. A randomized controlled trial comparing McKenzie therapy and motor control exercises on the recruitment of trunk muscles in people with chronic low back pain: a trial protocol. Physiotherapy. 2015;101(2):232-8. doi: 10.1016/ [PubMed: 25442673].
  • 18. Hoffman SL, Johnson MB, Zou D, Harris-Hayes M, Van Dillen LR. Effect of classification-specific treatment on lumbopelvic motion during hip rotation in people with low back pain. Man Ther. 2011;16(4):344-50. doi: 10.1016/j.math.2010.12.007. [PubMed: 21256073].
  • 19. Huijnen IP, Rusu AC, Scholich S, Meloto CB, Diatchenko L. Subgrouping of low back pain patients for targeting treatments: evidence from genetic, psychological, and activity-related behavioral approaches. Clin J Pain. 2015;31(2):123-32. doi: 10.1097/AJP.0000000000000100. [PubMed: 24681821].
  • 20. Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine (Phila Pa 1976). 2004;29(23):2593-602. [PubMed: 15564907].
  • 21. Hodges PW, van Dieen JH, Cholewicki J. Introduction:convergence and divergence of opinions on spinal control. Churchill Livingstone; 2013. doi: 10.1016/b978-0-7020-4356-7.00001-x.
  • 22. Licciardone JC, Gatchel RJ, Aryal S. Targeting Patient Subgroups With Chronic Low Back Pain for Osteopathic Manipulative Treatment: Responder Analyses From a Randomized Controlled Trial. J Am Osteopath Assoc. 2016;116(3):156-68. doi: 10.7556/jaoa.2016.032. [PubMed: 26927909].
  • 23. Apeldoorn AT, Ostelo RW, van Helvoirt H, Fritz JM, Knol DL, van Tulder MW, et al. A randomized controlled trial on the effectiveness of a classification-based system for subacute and chronic low back pain. Spine (Phila Pa 1976). 2012;37(16):1347-56. doi: 10.1097/BRS.0b013e31824d9f2b. [PubMed: 22333955].
  • 24. Kent P, Keating JL. Classification in nonspecific low back pain: what methods do primary care clinicians currently use? Spine (Phila Pa 1976). 2005;30(12):1433-40. [PubMed: 15959374].
  • 25. Smeets RJ, Maher CG, Nicholas MK, Refshauge KM, Herbert RD. Do psychological characteristics predict response to exercise and advice for subacute low back pain? Arthritis Rheum. 2009;61(9):1202-9. doi: 10.1002/art.24731. [PubMed: 19714601].
  • 26. Hall H, McIntosh G, Boyle C. Effectiveness of a low back pain classification system. Spine J. 2009;9(8):648-57. doi: 10.1016/j.spinee.2009.04.017. [PubMed: 19501026].
  • 27. Slater SL, Ford JJ, Richards MC, Taylor NF, Surkitt LD, Hahne AJ. The effectiveness of sub-group specific manual therapy for low back pain: a systematic review. Man Ther. 2012;17(3):201-12. doi: 10.1016/j.math.2012.01.006. [PubMed: 22386046].
  • 28. Surkitt LD, Ford JJ, Hahne AJ, Pizzari T, McMeeken JM. Efficacy of directional preference management for low back pain: a systematic review. Phys Ther. 2012;92(5):652-65. doi: 10.2522/ptj.20100251. [PubMed: 22247407].
  • 29. Van Dillen L, van Tulder M. Targeting interventions to patients: development and evaluation. In: Cholewicki J, Dieen JH, editors. Spinal Control. Churchill Livingstone; 2013. p. 195-205.
  • 30. Riddle DL. Classification and low back pain: a review of the literature and critical analysis of selected systems. Phys Ther. 1998;78(7):708-37. [PubMed: 9672545].
  • 31. Bellamy J. Vision Statement for the Physical Therapy Profession and Guiding Principles to Achieve the Vision. American Physical Therapy Association; 2013.
  • 32. Sahrmann SA. The human movement system: our professional identity. Phys Ther. 2014;94(7):1034-42. doi: 10.2522/ptj.20130319. [PubMed: 24627430].
  • 33. Karayannis NV, Jull GA, Hodges PW. Physiotherapy movement based classification approaches to low back pain: comparison of subgroups through review and developer/expert survey. BMC Musculoskelet Disord. 2012;13:24. doi: 10.1186/1471-2474-13-24. [PubMed: 22348236].
  • 34. Beneciuk JM, Bishop MD, George SZ. Clinical prediction rules for physical therapy interventions: a systematic review. Phys Ther. 2009;89(2):114-24. doi: 10.2522/ptj.20080239. [PubMed: 19095806].
  • 35. Patel S, Friede T, Froud R, Evans DW, Underwood M. Systematic review of randomized controlled trials of clinical prediction rules for physical therapy in low back pain. Spine (Phila Pa 1976). 2013;38(9):762-9. doi: 10.1097/BRS.0b013e31827b158f. [PubMed: 23132535].
  • 36. Furlan AD, Malmivaara A, Chou R, Maher CG, Deyo RA, Schoene M, et al. 2015 Updated Method Guideline for Systematic Reviews in the Cochrane Back and Neck Group. Spine (Phila Pa 1976). 2015;40(21):1660-73. doi: 10.1097/BRS.0000000000001061. [PubMed: 26208232].
  • 37. Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, et al. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 1998;51(12):1235-41. [PubMed: 10086815].
  • 38. Hahne AJ, Ford JJ, McMeeken JM. Conservative management of lumbar disc herniation with associated radiculopathy: a systematic review. Spine (Phila Pa 1976). 2010;35(11):E488-504. doi: 10.1097/BRS.0b013e3181cc3f56. [PubMed: 20421859].
  • 39. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713-21. [PubMed: 12882612].
  • 40. de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55(2):129-33. [PubMed: 19463084].
  • 41. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1-12. [PubMed: 8721797].
  • 42. Pennant M, Takwoingi Y, Pennant L, Davenport C, Fry-Smith A, Eisinga A, et al. A systematic review of positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) for the diagnosis of breast cancer recurrence. Health Technol Assess. 2010;14(50):1-103. doi: 10.3310/hta14500. [PubMed: 21044553].
  • 43. Cohen J. Statistical power analysis for the behavioral sciences (revised ed.). New York: Academic Press; 1977.
  • 44. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Wiley Online Library; 2008.
  • 45. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490. doi: 10.1136/bmj.328.7454.1490. [PubMed: 15205295].
  • 46. Schunemann H, Brozek J, Oxman A. GRADE handbook for grading quality of evidence and strength of recommendation Version 3.2. The GRADE Working Group; 2009. Available from:
  • 47. Browder DA, Childs JD, Cleland JA, Fritz JM. Effectiveness of an extension-oriented treatment approach in a subgroup of subjects with low back pain: a randomized clinical trial. Phys Ther. 2007;87(12):1608-18. discussion 1577-9. doi: 10.2522/ptj.20060297. [PubMed: 17895350].
  • 48. Fritz JM, Delitto A, Erhard RE. Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial. Spine (Phila Pa 1976). 2003;28(13):1363-71. discussion 1372. doi: 10.1097/01.BRS.0000067115.61673.FF. [PubMed: 12838091].
  • 49. Henry SM, Van Dillen LR, Ouellette-Morton RH, Hitt JR, Lomond KV, DeSarno MJ, et al. Outcomes are not different for patient-matched versus nonmatched treatment in subjects with chronic recurrent low back pain: a randomized clinical trial. Spine J. 2014;14(12):2799-810. doi: 10.1016/j.spinee.2014.03.024. [PubMed: 24662210].
  • 50. Petersen T, Larsen K, Nordsteen J, Olsen S, Fournier G, Jacobsen S. The McKenzie method compared with manipulation when used adjunctive to information and advice in low back pain patients presenting with centralization or peripheralization: a randomized controlled trial. Spine (Phila Pa 1976). 2011;36(24):1999-2010. doi: 10.1097/BRS.0b013e318201ee8e. [PubMed: 21358492].
  • 51. Saner J, Kool J, Sieben JM, Luomajoki H, Bastiaenen CH, de Bie RA. A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: A randomised controlled trial with one-year follow-up. Man Ther. 2015;20(5):672-9. doi: 10.1016/j.math.2015.02.005. [PubMed: 25770419].
  • 52. Saner J, Sieben JM, Kool J, Luomajoki H, Bastiaenen CH, de Bie RA. A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: Short-term results of a randomised controlled trial. J Bodyw Mov Ther. 2016;20(1):189-202. doi: 10.1016/j.jbmt.2015.08.001. [PubMed: 26891655].
  • 53. Sheeran L, van Deursen R, Caterson B, Sparkes V. Classification-guided versus generalized postural intervention in subgroups of nonspecific chronic low back pain: a pragmatic randomized controlled study. Spine (Phila Pa 1976). 2013;38(19):1613-25. doi: 10.1097/BRS.0b013e31829e049b. [PubMed: 23759804].
  • 54. Vibe Fersum K, O'Sullivan P, Skouen JS, Smith A, Kvale A. Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: a randomized controlled trial. Eur J Pain. 2013;17(6):916-28. doi: 10.1002/j.1532-2149.2012.00252.x. [PubMed: 23208945].
  • 55. Burns SA, Foresman E, Kraycsir SJ, Egan W, Glynn P, Mintken PE, et al. A treatment-based classification approach to examination and intervention of lumbar disorders. Sports Health. 2011;3(4):362-72. doi: 10.1177/1941738111410378. [PubMed: 23016029].
  • 56. Busanich BM, Verscheure SD. Does McKenzie therapy improve outcomes for back pain? J Athl Train. 2006;41(1):117-9. [PubMed: 16619104].
  • 57. Campbell CM, Edwards RR. Mind-body interactions in pain: the neurophysiology of anxious and catastrophic pain-related thoughts. Transl Res. 2009;153(3):97-101. doi: 10.1016/j.trsl.2008.12.002. [PubMed: 19218091].
  • 58. Frost H, Lamb SE, Stewart-Brown S. Responsiveness of a patient specific outcome measure compared with the Oswestry Disability Index v2.1 and Roland and Morris Disability Questionnaire for patients with subacute and chronic low back pain. Spine (Phila Pa 1976). 2008;33(22):2450-7. discussion 2458. doi: 10.1097/BRS.0b013e31818916fd. [PubMed: 18824951].
  • 59. Delitto A, Erhard RE, Bowling RW. A treatment-based classification approach to low back syndrome: identifying and staging patients for conservative treatment. Phys Ther. 1995;75(6):470-85. discussion 485-9. [PubMed: 7770494].
  • 60. Brown CA. The role of paradoxical beliefs in chronic pain: a complex adaptive systems perspective. Scand J Caring Sci. 2007;21(2):207-13. doi: 10.1111/j.1471-6712.2007.00457.x. [PubMed: 17559439].
  • 61. Luthi F. Chronic pain and activity: Avoidance, pacing... or persistence? Ann Phys Rehabil Med. 2016;59S:e52-3. doi: 10.1016/ [PubMed: 27676941].
  • 62. Edwards RR, Dworkin RH, Sullivan MD, Turk DC, Wasan AD. The Role of Psychosocial Processes in the Development and Maintenance of Chronic Pain. J Pain. 2016;17(9 Suppl):T70-92. doi: 10.1016/j.jpain.2016.01.001. [PubMed: 27586832].
  • 63. Vardeh D, Mannion RJ, Woolf CJ. Toward a Mechanism-Based Approach to Pain Diagnosis. J Pain. 2016;17(9 Suppl):T50-69. doi: 10.1016/j.jpain.2016.03.001. [PubMed: 27586831].
  • 64. Jazayeri SM. Study of Relationship Between Psycho-social Profile and Chronic Low-Back Pain (LBP). Iran Red Crescent Med J. 2006;2006(4):46-50.
  • 65. Turk DC, Rudy TE. Towards a comprehensive assessment of chronic pain patients. Behav Res Ther. 1987;25(4):237-49. [PubMed: 3662986].
  • 66. Kent P, Mjosund HL, Petersen DH. Does targeting manual therapy and/or exercise improve patient outcomes in nonspecific low back pain? A systematic review. BMC Med. 2010;8:22. doi: 10.1186/1741-7015-8-22. [PubMed: 20377854].
  • 67. Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain. 2005;113(1-2):9-19. doi: 10.1016/j.pain.2004.09.012. [PubMed: 15621359].
  • 68. Maughan EF, Lewis JS. Outcome measures in chronic low back pain. Eur Spine J. 2010;19(9):1484-94. doi: 10.1007/s00586-010-1353-6. [PubMed: 20397032].
  • 69. Younger J, McCue R, Mackey S. Pain outcomes: a brief review of instruments and techniques. Curr Pain Headache Rep. 2009;13(1):39-43. [PubMed: 19126370].
  • 70. Beattie P, Maher C. The role of functional status questionnaires for low back pain. Aust J Physiother. 1997;43(1):29-38. [PubMed: 11676670].
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments