Abstract
BackgroundManual therapy as spinal manipulation, spinal mobilization, stretching and massage are common treatment methods for neck and back pain. The objective was to compare the treatment effect on pain intensity, pain related disability and perceived recovery from a) naprapathic manual therapy (spinal manipulation, spinal mobilization, stretching and massage) to b) naprapathic manual therapy without spinal manipulation and to c) naprapathic manual therapy without stretching for male and female patients seeking care for back and/or neck pain.MethodParticipants were recruited among patients, ages 18–65, seeking care at the educational clinic of Naprapathögskolan - the Scandinavian College of Naprapathic Manual Medicine in Stockholm. The patients (n = 1057) were randomized to one of three treatment arms a) manual therapy (i.e. spinal manipulation, spinal mobilization, stretching and massage), b) manual therapy excluding spinal manipulation and c) manual therapy excluding stretching. The primary outcomes were minimal clinically important improvement in pain intensity and pain related disability. Treatments were provided by naprapath students in the seventh semester of eight total semesters. Generalized estimating equations and logistic regression were used to examine the association between the treatments and the outcomes.ResultsAt 12 weeks follow-up, 64 % had a minimal clinically important improvement in pain intensity and 42 % in pain related disability. The corresponding chances to be improved at the 52 weeks follow-up were 58 % and 40 % respectively. No systematic differences in effect when excluding spinal manipulation and stretching respectively from the treatment were found over 1 year follow-up, concerning minimal clinically important improvement in pain intensity (p = 0.41) and pain related disability (p = 0.85) and perceived recovery (p = 0.98). Neither were there disparities in effect when male and female patients were analyzed separately.ConclusionThe effect of manual therapy for male and female patients seeking care for neck and/or back pain at an educational clinic is similar regardless if spinal manipulation or if stretching is excluded from the treatment option.Trial registrationCurrent Controlled Trials ISRCTN92249294
Highlights
Manual therapy as spinal manipulation, spinal mobilization, stretching and massage are common treatment methods for neck and back pain
The corresponding chances to be improved at the 52 weeks follow-up were 58 % and 40 % respectively
No systematic differences in effect when excluding spinal manipulation and stretching respectively from the treatment were found over 1 year follow-up, concerning minimal clinically important improvement in pain intensity (p = 0.41) and pain related disability (p = 0.85) and perceived recovery (p = 0.98)
Summary
At baseline 1057 patients were randomized to one of three treatment alternatives. The period of recruitment was January 2010 to December 2012 and the follow-up of all patients was finished in January 2014. The joint test of difference – in the GEE framework taking repeated measurements at 7, 12, 26 and 52 weeks into consideration – showed no differences in effect between the three treatment arms, concerning the chance to have a MCI in pain intensity (p = 0.41; Wald test) and pain related disability (p = 0.85; Wald test) during 1 year follow-up (not in table). The joint test of difference – in the GEE framework taking repeated measurements at 7, 12, 26 and 52 weeks into consideration –showed no disparities between the treatment arms regarding mean score in pain intensity (p = 0.98; Wald test) and pain related disability (p = 0.88; Wald test) (not in table). The proportion that had not sought additional care for their neck/back pain the preceding three months at the 52-week follow-up was 61 % in all three treatment arms
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