OBJECTIVES: To study the relative efficacy of three different treatment for chronic low back pain (CLBP). Two preplanned comparisons were made: (a) Spinal manipulative therapy (SMT) combined with trunk strengthening exercises (TSE) vs. SMT combined with trunk stretching exercises, and (b) SMT combined with TSE vs. nonsteroidal anti-inflammatory drug (NSAID) therapy combined with TSE. STUDY DESIGN: Interdisciplinary, prospective, observer-blinded, randomized clinical trial with a 1-yr follow-up period. The trial evaluated therapies in combination only and was not designed to test the individual treatment components. SETTING: Primary contact, college out-patient clinic. PATIENTS: In total, 174 patients aged 20-60 yr were admitted to the study. MAIN OUTCOME MEASURES: Patient-rated low back pain, disability, and functional health status at 5 and 11 wk. INTERVENTIONS: Five weeks of SMT or NSAID therapy in combination with supervised trunk exercise, followed by and additional 6 wk of supervised exercise alone. RESULTS: Individual group comparisons after 5 and 11 wk of intervention on all three main outcome measures did not reveal any clear clinically important or statistically significant differences. There seemed to be a sustained reduction in medication use at the 1-yr follow-up. in the SMT/TSE group. Continuance of exercise during the follow-up year, regardless of type, was associated with a better outcome. CONCLUSION: Each of the three therapeutic regimens was associated with similar and clinically important improvement over time that was considered superior to the expected natural history of long-standing CLBP. For the management of CLBP, trunk exercise in combination with SMT or NSAID therapy seemed to be beneficial and worthwhile. The magnitude of nonspecific therapeutic (placebo) effects, cost-effectiveness and relative risks of side effects associated with these types of therapy need to be addressed in future studies.
RCT Entities:
OBJECTIVES: To study the relative efficacy of three different treatment for chronic low back pain (CLBP). Two preplanned comparisons were made: (a) Spinal manipulative therapy (SMT) combined with trunk strengthening exercises (TSE) vs. SMT combined with trunk stretching exercises, and (b) SMT combined with TSE vs. nonsteroidal anti-inflammatory drug (NSAID) therapy combined with TSE. STUDY DESIGN: Interdisciplinary, prospective, observer-blinded, randomized clinical trial with a 1-yr follow-up period. The trial evaluated therapies in combination only and was not designed to test the individual treatment components. SETTING: Primary contact, college out-patient clinic. PATIENTS: In total, 174 patients aged 20-60 yr were admitted to the study. MAIN OUTCOME MEASURES: Patient-rated low back pain, disability, and functional health status at 5 and 11 wk. INTERVENTIONS: Five weeks of SMT or NSAID therapy in combination with supervised trunk exercise, followed by and additional 6 wk of supervised exercise alone. RESULTS: Individual group comparisons after 5 and 11 wk of intervention on all three main outcome measures did not reveal any clear clinically important or statistically significant differences. There seemed to be a sustained reduction in medication use at the 1-yr follow-up. in the SMT/TSE group. Continuance of exercise during the follow-up year, regardless of type, was associated with a better outcome. CONCLUSION: Each of the three therapeutic regimens was associated with similar and clinically important improvement over time that was considered superior to the expected natural history of long-standing CLBP. For the management of CLBP, trunk exercise in combination with SMT or NSAID therapy seemed to be beneficial and worthwhile. The magnitude of nonspecific therapeutic (placebo) effects, cost-effectiveness and relative risks of side effects associated with these types of therapy need to be addressed in future studies.
Authors: Silvia Gianola; Pamela Frigerio; Michela Agostini; Rosa Bolotta; Greta Castellini; Davide Corbetta; Monica Gasparini; Paolo Gozzer; Erica Guariento; Linda C Li; Valentina Pecoraro; Valeria Sirtori; Andrea Turolla; Anita Andreano; Lorenzo Moja Journal: Physiother Can Date: 2016 Impact factor: 1.037
Authors: Gregory D Cramer; Jerrilyn Cambron; Joe A Cantu; Jennifer M Dexheimer; Judith D Pocius; Douglas Gregerson; Michael Fergus; Ray McKinnis; Thomas J Grieve Journal: J Manipulative Physiol Ther Date: 2013-05-03 Impact factor: 1.437
Authors: Luciana G Macedo; Bruno T Saragiotto; Tiê P Yamato; Leonardo O P Costa; Luciola C Menezes Costa; Raymond W J G Ostelo; Christopher G Maher Journal: Cochrane Database Syst Rev Date: 2016-02-10