low back pain ( lbp ) is one of the commonest musculoskeletal complaints and cause for 
 disability globally1 . conservative 
 treatment or non - operative management which includes physiotherapy is the main stay of 
 treatment for non - specific back pain whereas surgery is reserved for patients who have not 
 shown any improvement with conservative management or in those where specific causes for the 
 back pain or radicular pain has been identified2,3,4 . physiotherapy has been reported to be effective in relieving lbp and involves a 
 multidisciplinary approach aimed at regaining function and preventing disability2,3,4,5 . physiotherapy regimes for management of lbp are varied and include mckenzie lumbar spine 
 exercises , intensive strengthening , manipulation , device - based therapies , and low intensity 
 aerobics5,6,7,8,9 . device based therapy for 
 lbp involves quantitative assessment of muscle strength , resistance and lumbar motion and 
 tailoring the rehabilitation protocol based on this objective assessment . although several reports have analysed the effectiveness of standard physiotherapy for lbp , 
 literature is lacking in terms of effectiveness of device based therapy for lbp . to the best 
 of our knowledge , there are no studies in the literature which have reported effectiveness 
 of device based therapy for lbp . hence , the purpose of this study was to determine the 
 effectiveness of device based therapy for lbp . we retrospectively reviewed the clinical records of patients treated for low back pain 
 ( lbp ) using device - based physical therapy during a 1  year period between march 2013 and 
 march 2014 . the inclusion criteria were device - based physical therapy done for patients with 
 low back pain where red flags ( fever , recent trauma , pain at night or at rest , progressive 
 motor or sensory deficit , saddle anaesthesia , unexplained weight loss , history of cancer or 
 strong suspicion of cancer , history of osteoporosis or chronic steroid use , 
 immunosuppression , failure to improve after 6 weeks of conservative therapy ) were ruled out 
 using clinical history , examination and magnetic resonance imaging ( mri)10 , 11 . the exclusion criterion was incomplete clinical records where 
 demographic and clinical outcome data could not be obtained . based on the inclusion 
 criteria , clinical records of 250 patients were available for review . fifteen patients had 
 to be excluded due to incomplete records leaving 235 patient records for analysis . before induction into therapy , every patient underwent detailed assessment by a therapist 
 which included taking down detailed history , a thorough clinical examination and review of 
 their mri report . demographic details such as age , gender , height , weight , body mass index 
 ( bmi ) , and lifestyle and clinical history details such as duration of back pain , number of 
 previous episodes , past history of trauma or surgery , pain radiation was obtained from the 
 clinical records . the clinical examination included assessment of posture , lumbar spine 
 movement loss and flexibility , neurological and motor / myotome examination . pain before and 
 after treatment was recorded using the visual analogue scale ( vas ) system . functional 
 disability before and after treatment was recorded using the oswestry low back pain 
 disability score12 . the device - based physical therapy program followed a standardised protocol including 18 
 sessions spread over 6 weeks . the program began with pain control regime combined with the mckenzie lumbar spine 
 exercises . the purpose was to reduce the pain so that the patient can then be put on the 
 device for objective assessment of lumbar spine movement loss and flexibility and paraspinal 
 muscle strength and endurance using the david spine concept system ( david health solutions , 
 helsinki , finland ) . this machine is equipped with a knee - lock system and a thigh - restraining 
 belt to immobilize both hips and thighs which allowed the patient to move only the lower 
 back . the patient was then put on a customised protocol based on the readings of the device 
 which was plotted on a graph called the digital spine analysis ( dsa ) graph . the program 
 aimed to increase both strength and endurance of the back / paraspinal muscle with 15 to 20 
 repetitions every session on the device . if the patient was able to perform more than 20 
 repetitions of slow and controlled back extension and flexion movements , 22.5  kg was added 
 in the next training session . however , if the patient was able to perform less than 15 
 repetitions , the training load was lowered by 22.5  kg next time . post treatment outcome 
 measures such as vas score , oswestry score and category and functional ability were all 
 recorded after completion of 6 weeks of physical therapy . the pre and post treatment ( at the end of 6 weeks of device - based therapy ) outcome measures 
 of vas score , oswestry score and functional ability were compared using the student s t - test 
 for continuous data and fisher s exact test for categorical data . there were 142 male patients and 93 female patients with a mean age of 4413.8  years 
 ( range , 1784 years ) and a mean bmi of 26.54.3 ( kg / m ) . one hundred and 
 seventy - two patients reported to lead a sedentary lifestyle and 63 patients had a 
 semi - active to active lifestyle . the duration of low back pain ranged from days to years and 
 the most common lumbar spine level affected on mri was l4-s1 level . the common pathological 
 changes reported on lumbar mri included disc bulge , disc protrusion , disc herniation , 
 facetal arthropathy , spondylolisthesis and canal stenosis all outcome measures showed significant improvement at the end of 6 weeks of device - based 
 physical therapy . low back pain as measured by the mean vas score reduced significantly from 
 4.8 to 0.6 ( p=0.0001 ) whereas the mean oswestry score improved from 39 to 15.3 ( p=0.0001 ) 
 after treatment . before treatment , 73% of patients had moderate to severe disability owing 
 to their low back pain whereas after treatment this number dropped down to 28% . similarly , 
 the functional ability to perform daily tasks such as sitting ( 33% vs. 85% ) , standing ( 31% 
 vs. 81% ) and walking ( 29% vs. 85% ) also improved significantly after treatment 
 ( p=0.0001 ) . the current study sought to determine the effectiveness of device - based physical therapy 
 for treatment of low back pain . patients in our study showed significant reduction in vas 
 score for pain and oswestry disability score and improvement in functional ability thus 
 confirming that device - based therapy is quite effective in relieving pain , improving 
 function and reducing disability in patients with low back pain in the short term . the david spine concept system ( david health solutions , helsinki , finland ) used in this 
 study acts as a diagnostic tool and allows the therapist to determine functional deficit of 
 the lumbar spine which includes restriction of lumbar motion and strength of the paraspinal 
 muscles . hence , this device - based protocol helps the therapist to identify functional 
 deficits in each individual and tailor his treatment accordingly . literature is lacking for reports on the effectiveness of device - based therapy for 
 conservative management of low back pain . helmhout et al.12 conducted a randomised controlled trial in military recruits to 
 determine the effectiveness of device - supported specific lumbar extensor training compared 
 with regular physical therapy in subjects with nonspecific , nonacute lbp . they reported that 
 device - supported specific back strengthening did not offer greater benefits when compared to 
 routine physiotherapy in the treatment of lbp12 . however , their study population had stricter inclusion criteria 
 and had recruits with similar background whereas our study population showed greater 
 variability in terms of age , gender and lifestyle . furthermore , the device - supported therapy 
 used in the study by helmhout et al.12 
 involved specific lumbar extensor strengthening only unlike the treatment protocol in our 
 study which was varied based on variability in strength , motion and function as highlighted 
 by the david spine concept system . first , the retrospective design of this study has 
 its own limitations and inherent biases . second , the results reported are at the end of 6 
 weeks of therapy and the long term implications or effectiveness of device - based therapy in 
 the management of lbp is not known and needs to be studied further . finally , a 
 well - designed , prospective randomised trial needs to be undertaken to further confirm the 
 benefits and advantages of device - based therapy over regular physiotherapy for the 
 conservative management of lbp . in conclusion , device - based therapy is quite effective in relieving pain , improving 
 function and reducing disability in patients with low back pain at the end of 6 weeks of 
 therapy . device - based therapy may help to objectively evaluate the function of the spine and 
 paraspinal muscles and help the therapist tailor treatment accordingly .
[ purpose ] device based therapy for low back pain ( lbp ) involves quantitative assessment 
 of muscle strength , resistance and lumbar motion and tailoring the rehabilitation protocol 
 based on this objective assessment . 
 the purpose of this study was to determine the 
 effectiveness of device based therapy for lbp . 
 [ subjects and methods ] in this 
 retrospective study , clinical data of 235 patients who underwent device - based 
 physiotherapy for low back pain was reviewed . 
 pre and post - treatment outcome measures for 
 pain ( visual analogue scale or vas score ) , disability ( oswestry disability index ) and 
 functional ability were compared to determine effectiveness of device - based physiotherapy 
 at the end of 6 weeks of treatment . 
 [ results ] all outcome measures including vas score and 
 mean oswestry disability score showed significant improvement at the end of 6 weeks of 
 device - based physical therapy . before treatment , 73% of patients had moderate to severe 
 disability which reduced to 28% after treatment . 
 [ conclusion ] device - based therapy is 
 effective in relieving pain , improving function and reducing disability in patients with 
 low back pain in the short term . 
 device - based therapy may help to objectively evaluate the 
 function of the spine and paraspinal muscles and help the therapist tailor treatment 
 accordingly .