Inleiding
In de afgelopen decennia zijn honderden randomized controlled trials (RCT’s) gepubliceerd over de effectiviteit van conservatieve behandelmethoden bij aspecifieke lagerugpijn (Fritz, Cleland & Childs, 2007). Deze studies laten niet altijd dezelfde resultaten zien ten aanzien van de werkzaamheid van behandelmethoden en meestal zijn de aangetoonde effecten klein. Deze tegenvallende resultaten zijn vaak niet in overeenstemming met ervaringen vanuit de klinische setting, waarbij fysiotherapeuten patiënten goed, soms zelfs spectaculair zien reageren op specifieke interventies. Een veel geopperde verklaring voor de tegenvallende onderzoeksresultaten is dat bij onderzoek over het algemeen heterogene patiëntpopulaties worden geïncludeerd en er geen onderscheid wordt gemaakt tussen subgroepen (Hancock, Herbert & Maher, 2009). Wanneer specifieke interventies zoals manipulatie en graded activity worden onderzocht in heterogene populaties, is de kans groot dat de effectiviteit van deze behandelmethoden tegenvalt. Het gemiddelde behandelresultaat van de methode wordt dan immers verstoord (afgezwakt) door de matige of negatieve behandelresultaten bij patiënten voor wie de methode niet effectief is. Door specifieke behandelvormen te koppelen aan subgroepen die goed reageren op een bepaalde behandeling kan de effectiviteit van interventies bij patiënten met aspecifieke lagerugklachten worden verbeterd en de power bij onderzoek worden vergroot (Fritz, Cleland & Childs, 2007). Sinds 1996 wordt onderzoek naar klinisch relevante subgroepen beschouwd als topprioriteit in het onderzoeksveld van lagerugklachten (Borkan & Cherkin, 1996).
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Apeldoorn, A. (2014). Subgroepen bij patiënten met aspecifieke lagerugklachten: sleutel tot een betere behandeling?. In: Nijs, J., Calders, P., Geraets, J., Veenhof, C., van Wilgen, C., van Wegen, E. (eds) Jaarboek Fysiotherapie Kinesitherapie 2014. Bohn Stafleu van Loghum, Houten. https://doi.org/10.1007/978-90-368-0287-1_4
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