Article ; Online: Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial.
The spine journal : official journal of the North American Spine Society
2013 Volume 14, Issue 7, Page(s) 1106–1116
Abstract: ... relationship between visits to a chiropractor for spinal manipulation and chronic low back pain (cLBP) outcomes and ... for the care of any condition with spinal manipulation.: Purpose: To identify the dose-response ... differences from the no-manipulation control were found for 12 sessions (8.6 pain and 7.6 disability points, p ...
| Abstract | Background context: There have been no full-scale trials of the optimal number of visits for the care of any condition with spinal manipulation. Purpose: To identify the dose-response relationship between visits to a chiropractor for spinal manipulation and chronic low back pain (cLBP) outcomes and to determine the efficacy of manipulation by comparison with a light massage control. Study design/setting: Practice-based randomized controlled trial. Patient sample: Four hundred participants with cLBP. Outcome measures: The primary cLBP outcomes were the 100-point modified Von Korff pain intensity and functional disability scales evaluated at the 12- and 24-week primary end points. Secondary outcomes included days with pain and functional disability, pain unpleasantness, global perceived improvement, medication use, and general health status. Methods: One hundred participants with cLBP were randomized to each of four dose levels of care: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor. Participants were treated three times per week for 6 weeks. At sessions when manipulation was not assigned, they received a focused light massage control. Covariate-adjusted linear dose effects and comparisons with the no-manipulation control group were evaluated at 6, 12, 18, 24, 39, and 52 weeks. Results: For the primary outcomes, mean pain and disability improvement in the manipulation groups were 20 points by 12 weeks and sustainable to 52 weeks. Linear dose-response effects were small, reaching about two points per six manipulation sessions at 12 and 52 weeks for both variables (p<.025). At 12 weeks, the greatest differences from the no-manipulation control were found for 12 sessions (8.6 pain and 7.6 disability points, p<.025); at 24 weeks, differences were negligible; and at 52 weeks, the greatest group differences were seen for 18 visits (5.9 pain and 8.8 disability points, p<.025). Conclusions: The number of spinal manipulation visits had modest effects on cLBP outcomes above those of 18 hands-on visits to a chiropractor. Overall, 12 visits yielded the most favorable results but was not well distinguished from other dose levels. |
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| MeSH term(s) | Adult ; Female ; Humans ; Low Back Pain/therapy ; Male ; Manipulation, Spinal/methods ; Middle Aged ; Treatment Outcome | |||||
| Language | English | |||||
| Publishing date | 2013-10-16 | |||||
| Publishing country | United States | |||||
| Document type | Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural | |||||
| ZDB-ID | 2037072-6 | |||||
| ISSN | 1878-1632 ; 1529-9430 | |||||
| ISSN (online) | 1878-1632 | |||||
| ISSN | 1529-9430 | |||||
| DOI | 10.1016/j.spinee.2013.07.468 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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