Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain: A Randomized Clinical Trial
SOURCE: Spine (Phila Pa 1976). 2015 (Feb 15); 40 (4): 209–217
Schneider, Michael DC, PhD, Haas, Mitchell DC, MA
Glick, Ronald MD, Stevans, Joel DC, Landsittel, Doug PhD
School of Health and Rehabilitation Sciences,
Clinical and Translational Science Institute,
University of Pittsburgh,
STUDY DESIGN: Randomized controlled trial with follow-up to 6 months.
OBJECTIVE: This was a comparative effectiveness trial of manual-thrust manipulation (MTM) versus mechanical-assisted manipulation (MAM); and manipulation versus usual medical care (UMC).
SUMMARY OF BACKGROUND DATA: Low back pain (LBP) is one of the most common conditions seen in primary care and physical medicine practice. MTM is a common treatment for LBP. Claims that MAM is an effective alternative to MTM have yet to be substantiated. There is also question about the effectiveness of manipulation in acute and subacute LBP compared with UMC.
METHODS: A total of 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: MTM, MAM, or UMC. Outcome measures included the Oswestry LBP Disability Index (0-100 scale) and numeric pain rating (0-10 scale). Participants in the manipulation groups were treated twice weekly during 4 weeks; subjects in UMC were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months, and 6 months.
RESULTS: Linear regression showed a statistically significant advantage of MTM at 4 weeks compared with MAM (disability = –8.1, P = 0.009; pain = –1.4, P = 0.002) and UMC (disability = –6.5, P = 0.032; pain = –1.7, P < 0.001). Responder analysis, defined as 30% and 50% reductions in Oswestry LBP Disability Index scores revealed a significantly greater proportion of responders at 4 weeks in MTM (76%; 50%) compared with MAM (50%; 16%) and UMC (48%; 39%). Similar between-group results were found for pain: MTM (94%; 76%); MAM (69%; 47%); and UMC (56%; 41%). No statistically significant group differences were found between MAM and UMC, and for any comparison at 3 or 6 months.
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CONCLUSION: Manual-Thrust Manipulation (MTM) provides greater short-term reductions in self-reported disability and pain scores compared with Usual Medical Care (UMC) or Mechanical-Assisted Manipulation (MAM).
Keywords: Low back pain, spinal, manipulation, usual medical care, chiropractic, mechanical assisted manipulation, manual thrust manipulation, pain, disability
From the FULL TEXT Article:
Low back pain (LBP) is amongst the most common medical ailments and an important public health issue. Approximately 50% of U.S. working-age adults experience LBP each year  with a quarter of U.S. adults reporting an episode of back pain in the previous 3 months.  Back pain is the most common cause of disability for persons under the age of 45 and 1 of the most common reasons for office visits to primary care physicians in the U.S. [3, 4] as well as Europe and Australia. [5-7]
Spinal manipulative therapy (SMT) is used by chiropractors, physical therapists, and osteopathic physicians for the treatment of acute LBP. The most recent Cochrane Review concluded that SMT was no more effective than inert interventions, sham SMT, or usual medical interventions.  A recent meta-analysis using Bayesian methods concluded that the effectiveness of SMT is equivocal.  However other guidelines and systematic reviews have shown moderate effectiveness of manual SMT for the care of acute LBP. [10-13]