Every patient is different. Research from STOPS.physio helps to get specific treatment right
Few if any research teams have investigated the effect of treatment specific to the pathoanatomical, impairment, psychosocial and neurophysiological barriers to recovery. Clinical trials rarely publish detailed treatment protocols to allow practitioners to implement evidence-based care. Read on to explore how the STOPS specific approach to low back pain is effective and then download (click on the image) the full text papers and treatment protocols to allow you to improve your clinical practice today!
STOPS.physio for back pain summary
A 2 page summary of the essential components of the STOPS.physio approach to back pain.
Danazumi et al 2024 - Current Physiotherapy Assessment and Treatment Practices for Low Back Pain in Nigeria: A National Survey
The STOPS team are currently investigating the effectiveness of individualised physiotherapy in countries outside of Australia. This paper explores current physiotherapy practice for LBP in Nigeria as a prelude to the implementation study currently underway.
Liew et al 2021 - How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data
Individualised physiotherapy is an effective treatment for low back pain. We sought to determine how this treatment works by using randomised controlled trial data to develop a Bayesian Network model. Following analysis, we identified that individualised physiotherapy for low back pain appears to predominately work by facilitating an early reduction in disability, which in turn leads to improvements in other biopsychosocial outcomes. Click on the image to find out more.
Rich et al 2021 - Randomised, cross-over trial on the effect of isotonic and isometric exercise on pain and strength in proximal hamstring tendinopathy: trial protocol
Proximal hamstring tendinopathy (PHT) is a condition that occurs at all ages and levels of sporting participation. This paper details a prospective, cross-over randomised controlled trial study that investigates the effectiveness of isometric compared with isotonic exercise on pain and strength in people with PHT. The effect of isotonic versus isometric exercise on hamstring pain and strength will be determined using a repeated measures linear mixed model. Further analyses will determine the proportion of patients with clinically important pain and strength improvements. Click on the image to find out more.
Letter in response to: "Strategies to minimise concerns with selection bias in systematic reviews of interventions" by Ferreira et al
The image to the left is a screenshot of a letter published criticising our systematic review titled “Effects of specific muscle activation for low back pain on activity limitation, pain, work participation, or recurrence: a systematic review”. Our response to this letter has been accepted for publication by Musculoskeletal Science and Practice. Click on the image to find out more.
Ford Et Al 2020 - Effects of specific muscle activation for low back pain on activity limitation, pain, work participation, or recurrence: a systematic review
This study aimed to evaluate effectiveness of SMA on activity limitation, pain, work participation or recurrence for people with LBP. Specific muscle activation (SMA) is a common treatment for low back pain (LBP) however systematic reviews show variable effectiveness. Eligibility criteria incongruent with original descriptions of the SMA may be relevant. Click on the image to find out more.
ford et al 2020 - clinical features as predictors of histologically confirmed inflammation in patients with lumbar disc herniation with associated radiculopathy
This study aimed to identify which clinical features predicted the presence of histologically confirmed inflammation in patients with lumbar disc herniation with associated radiculopathy undergoing lumbar discectomy. Predictors included back pain < 5/10, symptoms worse the next day after injury, lumbar flexion range between 0 and 30° and a positive clinical inflammation score (at least 3 of: constant symptoms, morning pain/stiffness greater than 60-min, short walking not easing symptoms and significant night symptoms). These clinical features may enable targeted anti-inflammatory treatment in future RCTs and in clinical practice. Click on the image to find out more.
ford et al 2020 - a multivariate prognostic model for pain and activity limitation in people undergoing lumbar discectomy
This study aimed to identify a prognostic model identifying which patients undergoing lumbar discectomy would get better or not. A comprehensive range of prognostic factors reflective of both the biomedical and psychosocial domains were evaluated. The strongest factors were presence of a compensation claim, longer duration of injury and presence of below knee pain and/or paraesthesia as negative prognostic indicators and peripheralization in response to mechanical loading strategies as a positive prognostic indicator. Measures of psychosocial distress were not significant prognostic factors. Click on the image to find out more.
ford et al 2018 - DEVELOPMENT OF A MULTIVARIATE PROGNOSTIC MODEL FOR PAIN AND ACTIVITY LIMITATION IN PEOPLE WITH LOW BACK DISORDERS RECEIVING PHYSIOTHERAPY
This study aimed to identify a model that predicted which low back pain patients would get better or not. A comprehensive range of prognostic factors reflective of both the biomedical and psychosocial domains were evaluated. The strongest factors were pathoanatomical (eg type of provisional diagnosis) and physical (eg muscle function). These findings are unique and will inform future research and clinicians on potential ways of optimising treatment outcomes in people with back pain. Click on the image to find out more.
ford et al 2018 - effectiveness of stops on lumbar zygapophyseal joint pain
The STOPS trial on lumbar zygapophyseal joint (LZJ) pain evaluated the effectiveness of individualised manual therapy (IMT) plus guideline-based advice compared to advice alone in people with low back disorders and clinical features indicative of LZJ origin. All participants improved over time on all primary outcomes but the IMT group had greater and more rapid improvements in back pain (at 5, 10 and 26-weeks) and activity limitation (at 26 and 52-weeks) that was statistically and clinically important. Click on the image to find out more.
ford et al 2018 - THE STOPS TRIAL VERSUS COSTA ET AL. AN ACCURATE ANALYSIS
The assertion by Travers et al that the results of the STOPS trial should be reconsidered based on the negative impact of advice incorporating a pathoanatomical explanation is not substantiated. Specifically, the recovery trajectory of participants in the STOPS comparison group (guideline-based advice) who were most comparable to the participants in Costa et al were very similar to the trajectories depicted in that meta-analysis. Further, our RCT design in which both groups received the same guideline-based advice, controls for any effect of that intervention. We therefore stand by the results of the STOPS trial and assert strongly that our trial provides high quality evidence that individualised physiotherapy with advice is statistically and likely clinically significantly better than advice alone in improving outcomes for people with LBD. Click on the image to find out more.
Hahne et al 2017 - stops is more cost effective than advice
Advice has been advocated in all guidelines as a simple and cost effective treatment. However this landmark paper shows that individualised physiotherapy, although more costly to provide, more cost effective than advice. Large cost savings were attributable to reduced days off work. An incremental cost effectiveness ratio was $422 per quality-adjusted life year gained. Click on the image to find out more.
hahne et al 2017 - treatment effect modifiers from the stops trial
The STOPS trial showed that individualised physiotherapy was effective. However this pre-planned analysis of the STOPS data showed that individualised physiotherapy was even more effective in people with high Örebro scores (psychosocial risk factors) as well as longer or more severe back pain. So people with these features should be referred for individualised physiotherapy earlier rather than later. Click on the image to find out more.
hahne et al 2017 - effectiveness of stops on disc herniation
The STOPS trial on disc herniation extends the seminal work of the Saal brothers by evaluating the effectiveness of pain contingent functional restoration to guideline-based advice. All participants recovered well but the STOPS group had more rapid reduction in back pain at 10 weeks and improvement in function at 52 weeks. Click on the image to find out more.
Surkitt et al 2016 - RDP STOPS
The STOPS trial on a type of disc related pain called “reducible discogenic pain” evaluated the effectiveness of specific exercises, postures and movement on low back pain. All participants recovered well but the “directional preference management” recovered exceedingly rapidly by 5 weeks compared to advice which took 12 months to recover to the same degree. Click on the image to find out more.
Ford et al 2015 - the stops trial
This ground breaking study on 300 patients showed that specific physiotherapy was more effective than guideline recommended advice for early persistent pain. Between-group changes were sustained at 12 months for function as well as 6 months for back and leg pain and were also clinically important. Click on the image to find out more.
ford et al 2011 - manual therapy treatment protocol
The STOPS trial treatment program has been published in 4 separate papers (over 10,000 words each). These protocols explain through text, photos, tables and decision making algorithms how to implement the STOPS treatment. Part 1 outlines the manual therapy protocol based on the essential components of the Maitland approach including methods for clinical reasoning. Click on the image to find out more.
Ford et al 2011 - directional preference management protocol
This protocol outlines the essential components of managing low back pain according to the principles of Robin McKenzie. Learn how to diagnose reducible discogenic pain, provide directional preference strategies, progress forces, address lateral components and control posture. Highly effective in the STOPS trials for providing rapid relief from back and leg pain. Click on the image to find out more.
Ford et al 2012 - functional restoration treatment protocol
Some types of discogenic injuries are particularly resistant to standard physiotherapy methods. Learn how to diagnose the different types of discogenic problems and then apply functional restoration including precise specific muscle activation/motor control programs, management of inflammation, functional exercise progression, pacing, exacerbation management and sleep management. Click on the image to find out more.
ford et al 2012 - multifactorial persistent pain protocol
Functional restoration needs to be applied in a specific manner depending on the barriers to recovery. Learn how to diagnose psychosocial and neurophysiological barriers to recovery (in the absence of significant pathoanatomy) and then apply functional restoration including cognitive-behavioural methods, goal setting, graded activity/exercise, reducing passive treatment dependency and moving towards self management. Click on the image to find out more.
ford and hahne 2013 - the role of pathoanatomy
There is considerable controversy on the role of pathoanatomy particularly in low back pain. This paper evaluates the arguments commonly used to dismiss the relevance of pathoanatomy in clinical decision making. Click on the image to find out more.
Ford and Hahne 2013 - complexity and back pain
The management of back pain can be complex. This paper explores that complexity for clinicians and researchers with some challenging results. Click on the image to find out more.
Richards et al 2013 - Systematic review of physiotherapy functional restoration for LBP
This is the only high quality systematic review evaluating the effect of physiotherapy functional restoration in low back pain. Click on the image to find out more.
Slater, Ford et al 2012 - systematic review of specific manual therapy for back pain
This is one of the first systematic reviews to evaluate the effectiveness of manual therapy when applied in a specific manner. Some promising evidence emerges but more research is required. Click on the image to find out more.
Surkitt, ford et al 2012 - systematic review of specific directional preference management
This is one of the first systematic reviews to evaluate the effectiveness of the McKenzie approach (directional preference management) when applied in a specific manner. Some promising evidence emerges for the short term effect of this popular treatment. Click on the image to find out more.