Short-term effectiveness of spinal manipulative therapy versus functional technique in patients with chronic nonspecific low back pain: a pragmatic randomized controlled trial

被引:27
作者
Maria Castro-Sanchez, Adelaida [1 ]
Lara-Palomo, Inmaculada C. [1 ]
Mataran-Penarrocha, Guillermo A. [2 ]
Fernandez-de-las-Penas, Cesar [3 ,4 ]
Saavedra-Hernandez, Manuel [1 ]
Cleland, Joshua [5 ,6 ,7 ]
Encarnacion Aguilar-Ferrnandiz, Maria [8 ]
机构
[1] Univ Almeria, Dept Nursing Phys Therapy & Med, Carretera Sacramento S-N, Almeria 04120, Spain
[2] Primary Hlth Med, Andalusian Hlth Serv, Av Constituc 18, Almeria 41071, Spain
[3] Univ Rey Juan Carlos, Dept Phys Therapy Occupat Therapy Rehabil & Phys, Av Atenas S-N, Madrid 28922, Spain
[4] Univ Rey Juan Carlos, Esthesiol Lab, Dept Phys Therapy Occupat Therapy Rehabil & Phys, Av Atenas S-N, Alcorcon 28922, Spain
[5] Franklin Pierce Univ, Dept Phys Therapy, 40 Univ Dr Rindge, Concord, NH 03461 USA
[6] Concord Hosp, Rehabil Serv, 250 Pleasant St, Concord, NH 03301 USA
[7] Regis Univ, Manual Therapy Fellowship Program, 3333 Regis Blvd, Denver, CO 80221 USA
[8] Univ Granada, Dept Phys Therapy, Ave Madrid S-N, E-18071 Granada, Spain
关键词
Chronic pain; Low back pain; Manipulation; Quality of life; Randomized controlled trial; Disability evaluation; CLINICALLY IMPORTANT DIFFERENCE; ROLAND-MORRIS QUESTIONNAIRE; HEALTH SURVEY SF-36; SPANISH VERSION; PREDICTION RULE; MANAGEMENT; VALIDITY; OUTCOMES; RELIABILITY; VALIDATION;
D O I
10.1016/j.spinee.2015.08.057
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND CONTEXT: Chronic low back pain (LBP) is a prevalent condition associated with pain, disability, decreased quality of life, and fear of movement. To date, no studies have compared the effectiveness of spinal manipulation and functional technique for the management of this population. PURPOSE: This study aimed to compare the effectiveness of spinal manipulation and functional technique on pain, disability, kinesiophobia, and quality of life in patients with chronic LBP. STUDY DESIGN/SETTING: A single-blind pragmatic randomized controlled trial conducted in a university research clinic was carried out. PATIENT SAMPLE: Sixty-two patients (62% female, age: 45+/-7) with chronic LBP comprised the patient sample. OUTCOME MEASURES: Data on disability (Roland-Morris Disability Questionnaire [RMQ], Oswestry Low Back Pain Disability Index [ODI]), pain intensity (Numerical Pain Rate Scale [NPRS]), fear of movement (Tampa Scale of Kinesiophobia [TSK]), quality of life (Short Form-36 [SF-36] quality of life questionnaire), isometric resistance of abdominal muscles (McQuade test), and spinal mobility in flexion (finger-to-floor distance) were collected at baseline immediately after the intervention phase and at 1 month postintervention by an assessor blinded to group allocation of the patients. METHODS: Patients were randomly assigned to the spinal manipulative therapy group or the functional technique group and received three once-weekly sessions. RESULTS: In comparison to patients receiving functional technique, those receiving spinal manipulation experienced statistically, although not clinically, significant greater reductions in terms of RMQ (standardized mean difference in score changes between groups at post-treatment: 0.1; at 1 month: 0.1) and ODI (post-treatment: 2.9; at 1 month: 1.4). Linear longitudinal analysis showed a significant improvement in both groups over time for RMQ (manipulative: F=68.51, p<.001; functional: F=28.58, p<.001) and ODI (manipulative: F=104.66, p<.001; functional: F=32.15, p=.001). However, significant treatment-by-time interactions were not detected for pain intensity (p=.488), TSK (p=.552), any domains of the SF-36 quality of life questionnaire (p=.164), McQuade test (p=.512), and finger-to-floor distance (p=.194). Differences between and within groups were not clinically meaningful in any of the reported measures. CONCLUSIONS: In comparison to functional technique, spinal manipulative therapy showed greater reduction in disability in patients with chronic LBP, but not in terms of pain, fear of movement, quality of life, isometric resistance of trunk flexors, or spinal mobility. However, differences in disability were not clinically meaningful; therefore, spinal manipulative therapy did not result in any clinically important short-term benefits over functional technique therapy. In addition, as neither group met the threshold for minimum clinically important difference following treatment, neither treatment resulted in a clinically meaningful benefit. (C) 2016 Elsevier Inc. All rights reserved.
引用
收藏
页码:302 / 312
页数:11
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