MANIPULATIVE THERAPY VERSUS EDUCATION-PROGRAMS IN CHRONIC LOW-BACK-PAIN

Study Design. A randomized trial was conducted on a representative sam ple of patients with untreated low back pain lasting 7 weeks or longer , or having more than 6 episodes in 12 months. Objectives. To contrast the effectiveness of manipulation, a manipulation mimic, and a back e ducation program. Methodologic criticisms of earlier studies were addr essed. Summary of Background Data. Published meta-analyses suggest cli nical benefit from manipulation for acute patients. Data are inconclus ive for patients having symptoms for longer than 1 month. Methods. A t otal of 1267 consecutive patients were screened. Block randomization w as used to assign 209 qualifying patients to treatment groups. Self-re ported pain and activity tolerance served as primary outcome measures. Patients were assessed at enrollment, after 2 weeks of treatment, and again after 2 weeks without treatment. Multiple teams conducted recru itment, randomization, assessment, treatment, and data analysis indepe ndently without sharing information. Treatments were carefully describ ed, monitored, and balanced for physician attention and physical conta ct effects. Results. A total of 81.3% of subjects completed the study. Confounding factors and missing data were identified in approximately 20% of those completing the final follow-up. Analysis of the remainin g data was carried out. A strong time effect under treatment was obser ved. Greater improvement was noted in pain and activity tolerance in t he manipulation group. Immediate benefit from pain relief continued to accrue after manipulation, even for the last encounter at the end of the 2-week treatment interval. Conclusion. Time is a strong ally of th e low back pain patient. In human terms, however, there appears to be clinical value to treatment according to a defined plan using manipula tion even in low back pain exceeding 7 weeks' duration.