DOES MAINTAINED SPINAL MANIPULATION THERAPY FOR CHRONIC NON-SPECIFIC LOW BACK PAIN RESULT IN BETTER LONG TERM OUTCOME?
 
   

Does Maintained Spinal Manipulation Therapy for Chronic
Non-specific Low Back Pain Result in Better Long Term Outcome?

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:
   Frankp@chiro.org
 
   

FROM:   Spine (Phila Pa 1976) 2011 (Aug 15);   36 (18):   1427–1437

Senna, Mohammed K. MD; Machaly, Shereen A. MD

Address correspondence and reprint requests to Shereen A. Machaly, MD, Rheumatology and Rehabilitation Department, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt; E-mail: shmach_237@hotmail.com.


This new, single blinded placebo controlled study, conducted by the Mansoura Faculty of Medicine, conclusively demonstrates that maintenance care provides significant benefits for those with chronic low back pain.


Egyptian Study Shows Maintenance Care Helpful in Chronic Low Back Pain Treatment

FROM: Health Insights Today

In the first study of its kind, researchers at the Rheumatology and Rehabilitation Department at the Faculty of Medicine at Mansoura University in Egypt conducted a prospective single blinded placebo controlled study to assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic non-specific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low-back conditions after an initial phase of treatments.

The investigators noted that numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP but the efficacy of maintenance SMT in chronic non-specific LBP has not been studied. [Actually, the effect of Maintenance Care/Preventive Care SMT on chronic LBP was explored by Descarreaux (JMPT 2004) in a virtually identical study] Sixty patients with chronic, nonspecific LBP lasting at least 6 months were randomized to receive either (1) 12 treatments of sham SMT over a one-month period, (2) 12 treatments, consisting of SMT over a one-month period, but no treatments for the subsequent nine months, or (3) 12 treatments over a one-month period, along with “maintenance spinal manipulation” every two weeks for the following nine months.

To determine any difference among therapies, they measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1-month, 4-month, 7-month and 10-month intervals. Results were as follows: patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period (P = 0.0027 and 0.0029 respectively). However, only the third group that was given spinal manipulations during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation. In the no maintained SMT group, however, the mean pain and disability scores returned back near to their pretreatment level. Other key findings were that (a) after 1 month, both the SMT and SMT+Maintenance care cohorts showed a significant improvement in spinal flexion and bending, and (b) after 10 months, the SMT+Maintenance care cohort alone showed significant improvements in both spinal flexion and bending and the global assessment scale.

The authors concluded that spinal manipulation is effective for the treatment of chronic nonspecific LBP and that to obtain long-term benefit for the patient, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy can provide that additional benefit.



The Abstract:

Study Design:   A prospective single blinded placebo controlled study was conducted.

Objective :   To assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic non-specific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low-back conditions after an initial phase of treatments.

Summary of background:   SMT is a common treatment option for low back pain. Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP but the efficacy of maintenance SMT in chronic non-specific LBP has not been studied.

Subjects and Methods:   60 patients with chronic, nonspecific LBP lasting at least 6 months were randomized to receive either:

(1) 12 treatments of sham SMT over a one-month period,

(2) 12 treatments, consisting of SMT over a one-month period, but no treatments for the subsequent nine months, or

(3) 12 treatments over a one-month period, along with "maintenance spinal manipulation" every two weeks for the following nine months.

To determine any difference among therapies, we measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1-month, 4-month, 7-month and 10-month intervals.

Results:   Patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period (P = 0.0027 and 0.0029 respectively). However, only the third group that was given spinal manipulations during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation. In the no maintained SMT group, however, the mean pain and disability scores returned back near to their pretreatment level.

Conclusion   SMT is effective for the treatment of chronic non specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy.


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