OBJECTIVE: To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain. DESIGN: Randomized trial, 12-month follow-up. SETTING: Outpatient rehabilitation department. PARTICIPANTS: 210 patients with chronic, non-specific low back pain, 140/210 women, age 59 +/- 14 years. INTERVENTIONS: Back school and individual physiotherapy scheduled 15 1-hour-sessions for 3 weeks. Back school included: group exercise, education/ ergonomics; individual physiotherapy: exercise, passive mobilization and soft-tissue treatment. Spinal manipulation, given according to Manual Medicine, scheduled 4 to 6 20'-sessions once-a-week. OUTCOME: Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6) were assessed at baseline, discharge 3, 6, and 12 months. RESULTS:205 patients completed the study. At discharge, disability score decreased by 3.7 +/- 4.1 for back school, 4.4 +/- 3.7 for individual physiotherapy, 6.7 +/- 3.9 for manipulation; pain score reduction was 0.9 +/- 1.1, 1.1 +/- 1.0, 1.0 +/- 1.1, respectively. At 12 months, disability score reduction was 4.2 +/- 4.8 for back school, 4.0 +/- 5.1 for individual physiotherapy, 5.9 +/- 4.6 for manipulation; pain score reduction was 0.7 +/- 1.2, 0.4 +/- 1.3, and 1.5 +/- 1.1, respectively. Spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups (P < 0.001); pain recurrences and drug intake were also reduced compared to back school (P < 0.05) or individual physiotherapy (P < 0.001). CONCLUSIONS: Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.
RCT Entities:
OBJECTIVE: To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain. DESIGN: Randomized trial, 12-month follow-up. SETTING:Outpatient rehabilitation department. PARTICIPANTS: 210 patients with chronic, non-specific low back pain, 140/210 women, age 59 +/- 14 years. INTERVENTIONS:Back school and individual physiotherapy scheduled 15 1-hour-sessions for 3 weeks. Back school included: group exercise, education/ ergonomics; individual physiotherapy: exercise, passive mobilization and soft-tissue treatment. Spinal manipulation, given according to Manual Medicine, scheduled 4 to 6 20'-sessions once-a-week. OUTCOME: Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6) were assessed at baseline, discharge 3, 6, and 12 months. RESULTS: 205 patients completed the study. At discharge, disability score decreased by 3.7 +/- 4.1 for back school, 4.4 +/- 3.7 for individual physiotherapy, 6.7 +/- 3.9 for manipulation; pain score reduction was 0.9 +/- 1.1, 1.1 +/- 1.0, 1.0 +/- 1.1, respectively. At 12 months, disability score reduction was 4.2 +/- 4.8 for back school, 4.0 +/- 5.1 for individual physiotherapy, 5.9 +/- 4.6 for manipulation; pain score reduction was 0.7 +/- 1.2, 0.4 +/- 1.3, and 1.5 +/- 1.1, respectively. Spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups (P < 0.001); pain recurrences and drug intake were also reduced compared to back school (P < 0.05) or individual physiotherapy (P < 0.001). CONCLUSIONS: Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.
Authors: Patrícia Parreira; Martijn W Heymans; Maurits W van Tulder; Rosmin Esmail; Bart W Koes; Nolwenn Poquet; Chung-Wei Christine Lin; Christopher G Maher Journal: Cochrane Database Syst Rev Date: 2017-08-03
Authors: Anthony Delitto; Steven Z George; Linda Van Dillen; Julie M Whitman; Gwendolyn Sowa; Paul Shekelle; Thomas R Denninger; Joseph J Godges Journal: J Orthop Sports Phys Ther Date: 2012-03-30 Impact factor: 4.751
Authors: Mary O'Keeffe; Helen Purtill; Norelee Kennedy; Peter O'Sullivan; Wim Dankaerts; Aidan Tighe; Lars Allworthy; Louise Dolan; Norma Bargary; Kieran O'Sullivan Journal: BMJ Open Date: 2015-06-01 Impact factor: 2.692