OBJECTIVE: This is an observational prospective cohort study to explore the treatment effect of mechanical vs manual manipulation for acute low back pain. METHODS: Ninety-two patients with a history of acute low back pain were recruited from 3 private chiropractic offices, 2 of which used manual lumbar manipulation and 1 used mechanical instrument manipulation (Activator) as their primary modes of treatment. The chiropractors used their "treatment-as-usual" protocols for a maximum of 8 visits or 4 weeks, whichever occurred first. Primary outcome measures were changes in Numeric Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) scores from baseline to 4 weeks. The linear regression models were adjusted for baseline NPRS and ODI scores, age, and treatment expectancy. RESULTS: Comparison of baseline characteristics did not show any significant differences between the groups except for age (38.4 vs 49.7 years, P < .001) and treatment expectancy (5.7 vs 6.3, P = .003). Linear regression revealed significantly lower NPRS scores in the manual manipulation group at 4 weeks (beta = -1.2; 95% confidence interval, -2.1 to -.28) but no significant difference in ODI scores between the 2 groups at 4 weeks (beta = 1.5; 95% confidence interval, -8.3 to 2.4). Treatment expectancy, but not age, was found to have a significant main effect on both NPRS and ODI scores at 4 weeks. Exploratory analysis of the clinical patterns of care between the clinicians revealed significant differences in treatment frequency, duration, modality, and radiograph use between the 2 cohorts. CONCLUSIONS: This study highlights the challenges inherent with conducting research that allows for "treatment as usual." The data and experience derived from this investigational study will be used to design a future randomized clinical trial in which tighter controls will be imposed on the treatment protocol. Copyright 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
OBJECTIVE: This is an observational prospective cohort study to explore the treatment effect of mechanical vs manual manipulation for acute low back pain. METHODS: Ninety-two patients with a history of acute low back pain were recruited from 3 private chiropractic offices, 2 of which used manual lumbar manipulation and 1 used mechanical instrument manipulation (Activator) as their primary modes of treatment. The chiropractors used their "treatment-as-usual" protocols for a maximum of 8 visits or 4 weeks, whichever occurred first. Primary outcome measures were changes in Numeric Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) scores from baseline to 4 weeks. The linear regression models were adjusted for baseline NPRS and ODI scores, age, and treatment expectancy. RESULTS: Comparison of baseline characteristics did not show any significant differences between the groups except for age (38.4 vs 49.7 years, P < .001) and treatment expectancy (5.7 vs 6.3, P = .003). Linear regression revealed significantly lower NPRS scores in the manual manipulation group at 4 weeks (beta = -1.2; 95% confidence interval, -2.1 to -.28) but no significant difference in ODI scores between the 2 groups at 4 weeks (beta = 1.5; 95% confidence interval, -8.3 to 2.4). Treatment expectancy, but not age, was found to have a significant main effect on both NPRS and ODI scores at 4 weeks. Exploratory analysis of the clinical patterns of care between the clinicians revealed significant differences in treatment frequency, duration, modality, and radiograph use between the 2 cohorts. CONCLUSIONS: This study highlights the challenges inherent with conducting research that allows for "treatment as usual." The data and experience derived from this investigational study will be used to design a future randomized clinical trial in which tighter controls will be imposed on the treatment protocol. Copyright 2010 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.
Authors: Shane H Taylor; Nicole D Arnold; Lesley Biggs; Christopher J Colloca; Dale R Mierau; Bruce P Symons; John J Triano Journal: J Can Chiropr Assoc Date: 2004-06
Authors: Shane H Taylor; Nicole D Arnold; Lesley Biggs; Christopher J Colloca; Dale R Mierau; Bruce P Symons; John J Triano Journal: J Can Chiropr Assoc Date: 2004-03
Authors: Rob J E M Smeets; Saskia Beelen; Mariëlle E J B Goossens; Erik G W Schouten; J André Knottnerus; Johan W S Vlaeyen Journal: Clin J Pain Date: 2008-05 Impact factor: 3.442
Authors: William R Reed; Joel G Pickar; Randall S Sozio; Michael A K Liebschner; Joshua W Little; Maruti R Gudavalli Journal: J Manipulative Physiol Ther Date: 2017-06-17 Impact factor: 1.437
Authors: Walkyria Vilas Boas Fernandes; Cleofás Rodríguez Blanco; Fabiano Politti; Fernanda de Cordoba Lanza; Paulo Roberto Garcia Lucareli; João Carlos Ferrari Corrêa Journal: Trials Date: 2018-03-02 Impact factor: 2.279