Downtown Chiropractic Newsletter
Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain:
a randomized trial with one-year follow-up
Cecchi, F et al. Clinical Rehab 2010; 24(1):26-36
The findings of this study are exciting for chiropractors because they indicate that manipulation resulted in better long-term outcomes for patients with CLBP in terms of pain reduction, disability reduction, frequency of recurrences, and LBP - related use of drugs....
Methods: This randomized controlled trial compared spinal manipulation (SM), back school (BS), & individual physical therapy (PT) in the treatment of 205 CLBP Pts (reported having LBP "often" to "always" for 6 mo) (140 F, 70 M) with 12 months follow-up (F-U) in Italy. Patients (Pts) were randomized to either:
- Back school (BS) included group exercise, education/ergonomics (n=68) 15, 1-hour-sessions for 3 wks,
- Individual PT included exercise, passive mobilization and soft-tissue Tx (n=68) each for 15, 1-hour-sessions for 3 wks or
- SM (n=69) for 4 to 6 twenty minute sessions 1x/week for 4-6 weeks including mobilization (MO) and SM.
Outcomes: Roland Morris Disability Questionnaire, Pain Rating Scale at baseline, discharge 3, 6, & 12 months.
Results: SM Pts had better functional improvement and long-term pain relief than BS or PT, but received more treatments during F-U. Pain recurrences and drug use were reduced more for SM than BS or PT. SM Pts had more functional improvement than either PT or BS at discharge and across all F-Us. Pain relief at F-Us was signif better with SM. LBP recurrences and reduction of pain-related use of drugs were also better for SM. However, Pts in SM grp received more Tx during F-Us. Additional Tx consisted of short cycles of SM. Although SM had significantly better outcomes across all F-Us, the SM group had significantly more visits over the 12 months F-U. SM was less effective than PT in promoting self-management of recurrences, but better with pain control and disability reduction than BS or PT.
|Reduction in Disability at Discharge
|Reduction in Pain at Discharge
|Reduction in Disability at 12 mo
|Reduction in Pain at 12 mo
|Recurrences of LBP at 12 mo
|LBP related use of drugs
|Further visits for LBP Tx
Conclusions: SM provided better short and long-term functional improvement, as well as, more pain relief at F-U than BS or PT. However, the SM group had significantly more visits over the 12 months of follow-up than either BS or PT groups.
Comments: The findings of this study are exciting for chiropractors because they indicate that manipulation resulted in better long-term outcomes for patients with CLBP in terms of pain reduction, disability reduction, frequency of recurrences, and LBP - related use of drugs than either back school or individual physical therapy even though both the back school and the individual physical therapy groups care included active exercise training. It is also worth noting that both the BS & PT groups had 15 one hour sessions in 3 weeks, that is 5 one hour sessions a week for 3 weeks versus 4 -6 twenty minutes sessions in the SM group. Both the BS and PT groups had 15 hours of contact time versus only a maximum of 2 hours for the SM group. It is also important to note that there were many more follow-up visits in the SM group which were apparently needed to achieve/maintain these better long-term outcomes. It would be valuable to have another care group included in a subsequent study which includes both SM and the same type of exercise training as was used in either the BS or PT group.
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