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Short Term Treatment Versus Long Term Management of Neck and Back Disability in Older Adults Utilizing Spinal Manipulative Therapy and Supervised Exercise

By |August 30, 2017|Chronic Low Back Pain, Chronic Neck Pain, exercise|

Short Term Treatment Versus Long Term Management of Neck and Back Disability in Older Adults Utilizing Spinal Manipulative Therapy and Supervised Exercise: A Parallel-group Randomized Clinical Trial Evaluating Relative Effectiveness and Harms

The Chiro.Org Blog

SOURCE:   Chiropractic & Manual Therapies 2014 (Jul 23); 22: 26

Corrie Vihstadt, Michele Maiers,
Kristine Westrom, Gert Bronfort,
Roni Evans, Jan Hartvigsen and
Craig Schulz

Northwestern Health Sciencs University,
Wolfe-Harris Center for Clinical Studies,
2501 W 84th Street,
Bloomington 55431, MN, USA.

BACKGROUND:   Back and neck disability are frequent in older adults resulting in loss of function and independence. Exercise therapy and manual therapy, like spinal manipulative therapy (SMT), have evidence of short and intermediate term effectiveness for spinal disability in the general population and growing evidence in older adults. For older populations experiencing chronic spinal conditions, long term management may be more appropriate to maintain improvement and minimize the impact of future exacerbations. Research is limited comparing short courses of treatment to long term management of spinal disability. The primary aim is to compare the relative effectiveness of 12 weeks versus 36 weeks of SMT and supervised rehabilitative exercise (SRE) in older adults with back and neck disability.

METHODS/DESIGN:   Randomized, mixed-methods, comparative effectiveness trial conducted at a university-affiliated research clinic in the Minneapolis/St. Paul, Minnesota metropolitan area.

PARTICIPANTS:   Independently ambulatory community dwelling adults ≥ 65 years of age with back and neck disability of minimum 12 weeks duration (n = 200).

INTERVENTIONS:   12 weeks SMT + SRE or 36 weeks SMT + SRE.

RANDOMIZATION:   Blocked 1:1 allocation; computer generated scheme, concealed in sequentially numbered, opaque, sealed envelopes.

BLINDING:   Functional outcome examiners are blinded to treatment allocation; physical nature of the treatments prevents blinding of participants and providers to treatment assignment.

PRIMARY ENDPOINT:   36 weeks post-randomization.

DATA COLLECTION:   Self-report questionnaires administered at 2 baseline visits and 4, 12, 24, 36, 52, and 78 weeks post-randomization. Primary outcomes include back and neck disability, measured by the Oswestry Disability Index and Neck Disability Index. Secondary outcomes include pain, general health status, improvement, self-efficacy, kinesiophobia, satisfaction, and medication use. Functional outcome assessment occurs at baseline and week 37 for hand grip strength, short physical performance battery, and accelerometry. Individual qualitative interviews are conducted when treatment ends. Data on expectations, falls, side effects, and adverse events are systematically collected.

PRIMARY ANALYSIS:   Linear mixed-model method for repeated measures to test for between-group differences with baseline values as covariates.

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Low Back Pain and Chiropractic Page

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Exercise and Chiropractic Care Page

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Chronic Neck Pain and Chiropractic Page


Manual Therapy Followed by Specific Active Exercises

By |January 31, 2015|exercise, Spinal Manipulation|

Manual Therapy Followed by Specific Active Exercises Versus a Placebo Followed by Specific Active Exercises on the Improvement of Functional Disability in Patients with Chronic Non Specific Low Back Pain: A Randomized Controlled Trial

The Chiro.Org Blog

SOURCE:   BMC Musculoskelet Disord. 2012 (Aug 28);   13:   162

Pierre Balthazard, Pierre de Goumoens, Gilles Rivier,
Philippe Demeulenaere, Pierluigi Ballabeni, and Olivier Dériaz

Physiotherapy Department,
HES-SO University of Applied Sciences Western Switzerland-HESAV,
Avenue de Beaumont,
Lausanne 1011, Switzerland.

BACKGROUND:   Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE.

METHODS:   Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups.

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Low Back Pain and Chiropractic Page