Dr. Lise Stolze, MPT, DSc, PMA®-CPT
My Background
Pilates and movement have been a passion of mine for most of my life. I graduated with my Masters in physical therapy in 1993 from Wichita State University. My first experience with Pilates was in 1994 at the Pilates Center in Boulder, Colorado. I was impressed with the movement knowledge of Amy Taylor Alpers and Rachel Taylor Segel. The following year I completed a Pilates teacher training in Denver with Barbara Huttner, a protégé of Ron Fletcher. Working at The Phoenix Center in Denver, I received my Gyrotonic® certification with Angela Crowley and met Brent Anderson and Elizabeth Larkam, co-founders of Polestar Pilates. I participated in one of Polestar’s first teacher trainings and eventually became a Polestar educator. I attended Rocky Mountain University of Health Professions in Utah for my doctorate in orthopedic physical therapy and eventually opened my own practice in physical therapy, Pilates and Gyrotonic® in Denver Colorado called Stolze Therapies. I am a scoliosis specialist, certified with the Barcelona Scoliosis Physical Therapy School and now an educator for SSOL Schroth. I am currently conducting a study to help establish exercise guidelines for fitness professionals who coach adults with scoliosis. |
Contact details Website: https://www.stolzetherapies.com/ Email: [email protected] Instagram: @LiseStolze YouTube: @lisestolze9333 Facebook: Stolze Therapies |
My Research
For help with developing my research question, I met with Dr. Tim Flynn at Regis University PT Department, who suggested I first develop a Clinical Prediction Rule (CPR). He explained that patients with LBP are not a homogeneous group and should be classified into subgroups of individuals who share similar clinical characteristics to improve the strength of the clinical trial. The need to subgroup, or classify patients with nonspecific, heterogeneous diagnostic labels (such as LBP) into smaller categories based on likely response to a specific treatment has been identified as a central aspect of clinical decision making in physical therapy: https://academic.oup.com/ptj/article/86/1/122/2805195
The research committee chair and eventual co-author of my study was Dr. John Childs, who along with Tim Flynn helped develop the CPR for spinal manipulation. The CPR has 3 phases:
1) Development of the Rule – creation of a set of factors that have some diagnostic or prognostic accuracy
2) Clinical Trial - to determine if the predictor variables are generalizable to other patient populations or different practitioners
3) Impact Analysis - to determine if the CPR actually has an impact on practice patterns, outcomes of care or cost.
My study represents Phase 1.
Research Results
Ninety-six participants with LBP completed 8 weeks of Pilates Reformer exercises. See the study to view inclusion/exclusion criteria and more: https://www.jospt.org/doi/full/10.2519/jospt.2012.3826 ). Five attributes were shared by those who reported at least 50% improvement in pain after treatment:
1) Limited lumbar flexibility
2) Pain was not chronic
3) No acute herniated lumbar disc
4) High BMI (deconditioned)
5) Hip arthritis was not a potential cause of back pain.
If 3 or more of the 5 attributes were present, the probability of experiencing a successful outcome with Pilates exercise increased from 54% to 93%.
This study: Derivation of a Clinical Prediction Rule to Identify a Sub Group of Patients with Low Back Pain Likely to Benefit from Pilates-Based Exercise was published in the Journal of Orthopedic and Sports Physical therapy in 2012. The intention was for these predictive variables to be used to select the research subjects for Phase 2 of the CPR: the clinical trial.
Discussion:
My only regret is that we did not include belief questions as potential predictive variables, such as: Do you believe your back pain can improve? Do you believe exercising can improve your back pain? Do you believe stretching can improve your back pain? Do you believe Pilates can help your back pain? All these questions were pulled from my final set of predictors in the regression analysis on the advice of my committee members because they were considered to be obvious predictors of success. In other words, we already know that if you believe something will be effective, it increases the likelihood of its effectiveness and we were looking to confirm less obvious predictors.
Today more and more studies on low back pain are emphasizing quality of life and subjective criteria, and I think we should have included these belief questions in our study. While Phase 1 of this CPR is finished, the predictive variables produced by the study still need to be validated with a clinical trial.
The Future:
As a scoliosis specialist I am concerned about the lack of knowledge in the Pilates community about scoliosis and adult spinal conditions. Much of the research on this population today involves pelvic sagittal parameters that help predict spinal deformity in adulthood. It is an interesting topic and it would be helpful to all Pilates instructors who work with adults to understand how a client’s congenital structure affects their posture and why maintaining an optimal sagittal profile is more important as we age. Perhaps that will be the subject of my next study!
For help with developing my research question, I met with Dr. Tim Flynn at Regis University PT Department, who suggested I first develop a Clinical Prediction Rule (CPR). He explained that patients with LBP are not a homogeneous group and should be classified into subgroups of individuals who share similar clinical characteristics to improve the strength of the clinical trial. The need to subgroup, or classify patients with nonspecific, heterogeneous diagnostic labels (such as LBP) into smaller categories based on likely response to a specific treatment has been identified as a central aspect of clinical decision making in physical therapy: https://academic.oup.com/ptj/article/86/1/122/2805195
The research committee chair and eventual co-author of my study was Dr. John Childs, who along with Tim Flynn helped develop the CPR for spinal manipulation. The CPR has 3 phases:
1) Development of the Rule – creation of a set of factors that have some diagnostic or prognostic accuracy
2) Clinical Trial - to determine if the predictor variables are generalizable to other patient populations or different practitioners
3) Impact Analysis - to determine if the CPR actually has an impact on practice patterns, outcomes of care or cost.
My study represents Phase 1.
Research Results
Ninety-six participants with LBP completed 8 weeks of Pilates Reformer exercises. See the study to view inclusion/exclusion criteria and more: https://www.jospt.org/doi/full/10.2519/jospt.2012.3826 ). Five attributes were shared by those who reported at least 50% improvement in pain after treatment:
1) Limited lumbar flexibility
2) Pain was not chronic
3) No acute herniated lumbar disc
4) High BMI (deconditioned)
5) Hip arthritis was not a potential cause of back pain.
If 3 or more of the 5 attributes were present, the probability of experiencing a successful outcome with Pilates exercise increased from 54% to 93%.
This study: Derivation of a Clinical Prediction Rule to Identify a Sub Group of Patients with Low Back Pain Likely to Benefit from Pilates-Based Exercise was published in the Journal of Orthopedic and Sports Physical therapy in 2012. The intention was for these predictive variables to be used to select the research subjects for Phase 2 of the CPR: the clinical trial.
Discussion:
My only regret is that we did not include belief questions as potential predictive variables, such as: Do you believe your back pain can improve? Do you believe exercising can improve your back pain? Do you believe stretching can improve your back pain? Do you believe Pilates can help your back pain? All these questions were pulled from my final set of predictors in the regression analysis on the advice of my committee members because they were considered to be obvious predictors of success. In other words, we already know that if you believe something will be effective, it increases the likelihood of its effectiveness and we were looking to confirm less obvious predictors.
Today more and more studies on low back pain are emphasizing quality of life and subjective criteria, and I think we should have included these belief questions in our study. While Phase 1 of this CPR is finished, the predictive variables produced by the study still need to be validated with a clinical trial.
The Future:
As a scoliosis specialist I am concerned about the lack of knowledge in the Pilates community about scoliosis and adult spinal conditions. Much of the research on this population today involves pelvic sagittal parameters that help predict spinal deformity in adulthood. It is an interesting topic and it would be helpful to all Pilates instructors who work with adults to understand how a client’s congenital structure affects their posture and why maintaining an optimal sagittal profile is more important as we age. Perhaps that will be the subject of my next study!