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Aspinall SL, Nim C, Hartvigsen J, Cook CE, Skillgate E, Vogel S, Hohenschurz-Schmidt D, Underwood M, Rubinstein SM. Waste not, want not: call to action for spinal manipulative therapy researchers. Chiropr Man Therap 2024; 32:16. [PMID: 38745213 PMCID: PMC11092111 DOI: 10.1186/s12998-024-00539-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/01/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Research waste is defined as research outcomes with no or minimal societal benefits. It is a widespread problem in the healthcare field. Four primary sources of research waste have been defined: (1) irrelevant or low priority research questions, (2) poor design or methodology, (3) lack of publication, and (4) biased or inadequate reporting. This commentary, which was developed by a multidisciplinary group of researchers with spinal manipulative therapy (SMT) research expertise, discusses waste in SMT research and provides suggestions to improve future research. MAIN TEXT This commentary examines common sources of waste in SMT research, focusing on design and methodological issues, by drawing on prior research and examples from clinical and mechanistic SMT studies. Clinical research is dominated by small studies and studies with a high risk of bias. This problem is compounded by systematic reviews that pool heterogenous data from varying populations, settings, and application of SMT. Research focusing on the mechanisms of SMT often fails to address the clinical relevance of mechanisms, relies on very short follow-up periods, and has inadequate control for contextual factors. CONCLUSIONS This call to action is directed to researchers in the field of SMT. It is critical that the SMT research community act to improve the way research is designed, conducted, and disseminated. We present specific key action points and resources, which should enhance the quality and usefulness of future SMT research.
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Affiliation(s)
| | - Casper Nim
- Medical Research Unit, Spine Centre of Southern Denmark, University Hospital of Southern Denmark, Middelfart, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Center for Muscle and Joint Health, Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Chad E Cook
- Department of Orthopaedics, Department of Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Eva Skillgate
- Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Naprapathögskolan, Scandinavian College of Naprapathic Manual Medicine, Stockholm, Sweden
| | - Steven Vogel
- Research Centre, University College of Osteopathy, London, UK
| | - David Hohenschurz-Schmidt
- Research Centre, University College of Osteopathy, London, UK
- Pain Research, Department of Surgery & Cancer, Imperial College London, London, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | - Sidney M Rubinstein
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, the Netherlands
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2
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Grenier JP, Rothmund M. A critical review of the role of manual therapy in the treatment of individuals with low back pain. J Man Manip Ther 2024:1-14. [PMID: 38381584 DOI: 10.1080/10669817.2024.2316393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/04/2024] [Indexed: 02/23/2024] Open
Abstract
The number of low back pain (LBP) cases is projected to increase to more than 800 million by 2050. To address the substantial burden of disease associated with this rise in prevalence, effective treatments are needed. While clinical practice guidelines (CPG) consistently recommend non-pharmacological therapies as first-line treatments, recommendations regarding manual therapy (MT) in treating low back pain vary. The goal of this narrative review was to critically summarize the available evidence for MT behind these recommendations, to scrutinize its mechanisms of action, and propose some actionable steps for clinicians on how this knowledge can be integrated into a person-centered approach. Despite disparate recommendations from CPG, MT is as effective as other available treatments and may be offered to patients with LBP, especially as part of a treatment package with exercise and education. Most of the effects of MT are not specific to the technique. MT and other interventions share several mechanisms of action that mediate treatment success. These mechanisms can encompass patients' expectations, prior experiences, beliefs and convictions, epistemic trust, and nonspecific contextual effects. Although MT is safer than opioids for patients with LBP, this alone is insufficient. Our goal is to encourage clinicians to shift away from outdated and refuted ideas in MT and embrace a person-centered approach rooted in a comprehensive biopsychosocial framework while incorporating patients' beliefs, addressing illness behaviors, and seeking to understand each patient's journey.
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Affiliation(s)
- Jean-Pascal Grenier
- Department of Physiotherapy, Health University of Applied Sciences Tyrol, Innsbruck, Austria
- Department of Internal Medicine II, University Clinic Innsbruck, Innsbruck, Austria
| | - Maria Rothmund
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, University Clinic for Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
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Kurashima Y, Nakamura T, Mukaiyama T, Hasegawa K, Kuruma H. Investigation for Factors Affecting Body Perception Disturbance in Patients with Low Back Pain by Mechanism-Based Classification of Pain: A Cross-Sectional Study. Pain Res Manag 2023; 2023:5083084. [PMID: 37953807 PMCID: PMC10635744 DOI: 10.1155/2023/5083084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 09/15/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
Abstract
Background Central sensitization is a pathophysiological cause of chronic low back pain and is linked with psychosocial factors. The association between central sensitization (CS) and body perception disturbance is currently unclear, and no prior studies have investigated this relationship in patients with acute or subacute low back pain. The objective of this study was to investigate potential factors that influence body perception disturbance using a mechanistic classification of low back pain. Methods This cross-sectional study was conducted at the time of initial physical therapy in patients with low back pain. During the study period, 169 patients were recruited. Pain intensity, disease duration, disability, CS, and body perception disturbance were evaluated. Patients were divided into three groups according to the pathology of low back pain, and multivariate analysis was used to examine factors affecting body perception disturbance. The dependent variable was Fremantle Back Awareness Questionnaire (FreBAQ); the independent variables were age, gender, BMI, VAS, disease duration, RDQ, and CS Inventory-9 (CSI-9). Results A total of 117 patients were included in our analysis. According to the mechanistic classification of pain, 66 (56.4%), 36 (30.8%), and 15 (12.8%) patients were categorized as having nociceptive pain (NP), peripheral neuropathic pain (PNP), and CS pain (CSP), respectively. Patients with PNP or CSP were significantly older than those with NP (p < 0.01). FreBAQ and RDQ scores were significantly higher in patients with CSP than those with NP (p < 0.05). The results of multiple regression analyses indicated that CSI-9 scores were significantly associated with FreBAQ (p < 0.01). Conclusion Patients with CS syndrome and low back pain tend to have higher CSI-9 scores and be older. Body perception disturbance is influenced by CS or CS syndrome, regardless of the stage of low back pain, suggesting that patients with chronic low back pain tend to have low body image.
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Affiliation(s)
- Yoshito Kurashima
- Tokyo Spine Hospital, Tokyo, Japan
- Department of Physical Therapy Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | | | | | | | - Hironobu Kuruma
- Department of Physical Therapy Sciences, Tokyo Metropolitan University, Tokyo, Japan
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Rodríguez-Pastor JA, Caro-Puértolas B, Caña-Pino A, Sánchez-Preciado AM, Garrido-Ardila EM, Apolo-Arenas MD. Effect of osteopathic manipulation of the sacroiliac joint vs electrotherapy on pain and functional disability in patients with low back pain: A pilot study. J Back Musculoskelet Rehabil 2022; 35:1219-1226. [PMID: 35599463 DOI: 10.3233/bmr-210120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND One of the main problems faced by physiotherapists in primary care is low back pain with or without radiation to lower limbs. There are many different treatment approaches for the management of low back pain. Despite the large amount of published studies, the evidence remains contradictory. OBJECTIVE To evaluate the influence of the osteopathic manipulation of the sacroiliac joint on low back pain with or without radiation to lower limbs. METHOD Single-blind randomized clinical controlled trial. Participants with low back pain with or without lower limb radiation were randomized to osteopathic manipulation of the sacroiliac joint group (intervention, 6 sessions) or to an electrotherapy group (control, 15 sessions) for 3 weeks. Measures were taken at baseline (week 0) and post-intervention (week 4). The primary outcome measures were pain (Visual Analogue Scale), functional disability (Oswestry disability index and Roland Morris questionnaire). The secondary outcome measure was pain threshold at muscular tender points in the quadratus lumborum, pyramidal, mayor gluteus, and hamstrings. RESULTS In all, 37 participants completed the study. The results of the intragroup comparisons showed statistically significant improvements in both groups in the visual analogue scale (Osteopathic manipulation group, P= 0.000; Electrotherapy group, P= 0.005) and Oswestry disability index (Osteopathic manipulation group, P= 0.000; Electrotherapy group- P= 0.026) but not in the Roland Morris questionnaire (P= 0.121), which only improved in the intervention group (P= 0.01). The osteopathic manipulation was much more effective than electrotherapy improving to pain and functional disability. CONCLUSION Osteopathic manipulation of the sacroiliac joint improves pain and disability in patients with sacroiliac dysfunction after three weeks of treatment.
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Affiliation(s)
- José Antonio Rodríguez-Pastor
- Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
| | - Berta Caro-Puértolas
- Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
| | - Alejandro Caña-Pino
- Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
| | | | - Elisa María Garrido-Ardila
- ADOLOR Research group, Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
| | - Ma Dolores Apolo-Arenas
- Department of Medical Surgical-Therapy, Faculty of Medicine and Health Sciences, Extremadura University, Badajoz, Spain
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Abstract
STUDY DESIGN The 2001 Functional Rating Index (FRI) was not developed under today's standard psychometric analysis. The original data of 108 cases were re-analyzed using Rasch item response theory. In 2015, 2 alternative forms were administered to an additional 140 patients for establishing and perhaps improving its psychometric characteristics. OBJECTIVE To evaluate the FRI with item response theory. SUMMARY OF BACKGROUND DATA The 2001 FRI data showed internal agreement among items and weak item-total correlation items. The FRI's true reliability and validity were never established. METHODS The original 2001 FRI 108 and two new versions with 140 respondents with back pain were compared by Rasch analysis for unidimensionality, local independence, monotonicity, and differential item functioning. RESULTS All three versions exhibited more than the requisite single latent construct. The original Form 2001 had two items that were non-monotonic, four with differential item functioning (DIF), five with poor infit, and four with poor outfit. Form B had five nonmonotonic items, five had DIF, three had poor infit, and three had poor outfit. Form C had only monotonic items, one item with DIF, three items with poor infit, and two with poor outfit. CONCLUSION The original FRI and alternative forms all fail failed crucial psychometric tests and fail to accurately measure more than one latent construct. It is thus unfit as a pain, function, and disability assessment. Only reducing the number of Likert choices improved the test. Other back pain assessments should be used instead, and all surveys would benefit from periodic item responses to adjust to shifts in grammar and meaning.Level of Evidence: 3.
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Shirado O, Arai Y, Iguchi T, Imagama S, Kawakami M, Nikaido T, Ogata T, Orita S, Sakai D, Sato K, Takahata M, Takeshita K, Tsuji T. Formulation of Japanese Orthopaedic Association (JOA) clinical practice guideline for the management of low back pain- the revised 2019 edition. J Orthop Sci 2022; 27:3-30. [PMID: 34836746 DOI: 10.1016/j.jos.2021.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The latest clinical guidelines are mandatory for physicians to follow when practicing evidence-based medicine in the treatment of low back pain. Those guidelines should target not only Japanese board-certified orthopaedic surgeons, but also primary physicians, and they should be prepared based entirely on evidence-based medicine. The Japanese Orthopaedic Association Low Back Pain guideline committee decided to update the guideline and launched the formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline with the latest data of evidence-based medicine. METHODS The Japanese Orthopaedic Association Low Back Pain guideline formulation committee revised the previous guideline based on a method for preparing clinical guidelines in Japan proposed by Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Two key phrases, "body of evidence" and "benefit and harm balance" were focused on in the revised version. Background and clinical questions were determined, followed by literature search related to each question. Appropriate articles were selected from all the searched literature. Structured abstracts were prepared, and then meta-analyses were performed. The strength of both the body of evidence and the recommendation was decided by the committee members. RESULTS Nine background and nine clinical qvuestions were determined. For each clinical question, outcomes from the literature were collected and meta-analysis was performed. Answers and explanations were described for each clinical question, and the strength of the recommendation was decided. For background questions, the recommendations were described based on previous literature. CONCLUSIONS The 2019 clinical practice guideline for the management of low back pain was completed according to the latest evidence-based medicine. We strongly hope that this guideline serves as a benchmark for all physicians, as well as patients, in the management of low back pain.
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Affiliation(s)
- Osamu Shirado
- Department of Orthopaedic and Spinal Surgery, Aizu Medical Center (AMEC) at Fukushima Medical University, Japan.
| | - Yoshiyasu Arai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Japan
| | - Tetsuhiro Iguchi
- Department of Orthopaedic Surgery, Saiseikai Hyogo Prefectural Hospital, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | | | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
| | | | - Sumihisa Orita
- Center for Frontier Medical Engineering (CFME), Department of Orthopaedic Surgery, Chiba University, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Japan
| | - Kimiaki Sato
- Department of Orthopaedic Surgery, Kurume University, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
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Nguyen C, Boutron I, Zegarra-Parodi R, Baron G, Alami S, Sanchez K, Daste C, Boisson M, Fabre L, Krief P, Krief G, Lefèvre-Colau MM, Rannou F. Effect of Osteopathic Manipulative Treatment vs Sham Treatment on Activity Limitations in Patients With Nonspecific Subacute and Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Intern Med 2021; 181:620-630. [PMID: 33720272 PMCID: PMC7961471 DOI: 10.1001/jamainternmed.2021.0005] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Osteopathic manipulative treatment (OMT) is frequently offered to people with nonspecific low back pain (LBP) but never compared with sham OMT for reducing LBP-specific activity limitations. OBJECTIVE To compare the efficacy of standard OMT vs sham OMT for reducing LBP-specific activity limitations at 3 months in persons with nonspecific subacute or chronic LBP. DESIGN, SETTING, AND PARTICIPANTS This prospective, parallel-group, single-blind, single-center, sham-controlled randomized clinical trial recruited participants with nonspecific subacute or chronic LBP from a tertiary care center in France starting February 17, 2014, with follow-up completed on October 23, 2017. Participants were randomly allocated to interventions in a 1:1 ratio. Data were analyzed from March 22, 2018, to December 5, 2018. INTERVENTIONS Six sessions (1 every 2 weeks) of standard OMT or sham OMT delivered by nonphysician, nonphysiotherapist osteopathic practitioners. MAIN OUTCOMES AND MEASURES The primary end point was mean reduction in LBP-specific activity limitations at 3 months as measured by the self-administered Quebec Back Pain Disability Index (score range, 0-100). Secondary outcomes were mean reduction in LBP-specific activity limitations; mean changes in pain and health-related quality of life; number and duration of sick leaves, as well as number of LBP episodes at 12 months; and consumption of analgesics and nonsteroidal anti-inflammatory drugs at 3 and 12 months. Adverse events were self-reported at 3, 6, and 12 months. RESULTS Overall, 200 participants were randomly allocated to standard OMT and 200 to sham OMT, with 197 analyzed in each group; the median (range) age at inclusion was 49.8 (40.7-55.8) years, 235 of 394 (59.6%) participants were women, and 359 of 393 (91.3%) were currently working. The mean (SD) duration of the current LBP episode was 7.5 (14.2) months. Overall, 164 (83.2%) patients in the standard OMT group and 159 (80.7%) patients in the sham OMT group had the primary outcome data available at 3 months. The mean (SD) Quebec Back Pain Disability Index scores for the standard OMT group were 31.5 (14.1) at baseline and 25.3 (15.3) at 3 months, and in the sham OMT group were 27.2 (14.8) at baseline and 26.1 (15.1) at 3 months. The mean reduction in LBP-specific activity limitations at 3 months was -4.7 (95% CI, -6.6 to -2.8) and -1.3 (95% CI, -3.3 to 0.6) for the standard OMT and sham OMT groups, respectively (mean difference, -3.4; 95% CI, -6.0 to -0.7; P = .01). At 12 months, the mean difference in mean reduction in LBP-specific activity limitations was -4.3 (95% CI, -7.6 to -1.0; P = .01), and at 3 and 12 months, the mean difference in mean reduction in pain was -1.0 (95% CI, -5.5 to 3.5; P = .66) and -2.0 (95% CI, -7.2 to 3.3; P = .47), respectively. There were no statistically significant differences in other secondary outcomes. Four and 8 serious adverse events were self-reported in the standard OMT and sham OMT groups, respectively, though none was considered related to OMT. CONCLUSIONS AND RELEVANCE In this randomized clinical trial of patients with nonspecific subacute or chronic LBP, standard OMT had a small effect on LBP-specific activity limitations vs sham OMT. However, the clinical relevance of this effect is questionable. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02034864.
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Affiliation(s)
- Christelle Nguyen
- UFR de Médecine, Faculté de Santé, Université de Paris, Paris, France.,AP-HP.Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France.,INSERM UMRS-1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Paris, France
| | - Isabelle Boutron
- UFR de Médecine, Faculté de Santé, Université de Paris, Paris, France.,AP-HP.Centre-Université de Paris, Hôpital Hôtel-Dieu, Centre d'Épidémiologie Clinique, Paris, France.,INSERM UMRS-1153, Centre de Recherche Épidémiologie et Statistique, METHODS Team, Paris, France
| | - Rafael Zegarra-Parodi
- A.T. Still Research Institute, A.T. Still University, Kirksville, Missouri.,COME Collaboration, Pescara, Italy.,School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Gabriel Baron
- AP-HP.Centre-Université de Paris, Hôpital Hôtel-Dieu, Centre d'Épidémiologie Clinique, Paris, France.,INSERM UMRS-1153, Centre de Recherche Épidémiologie et Statistique, METHODS Team, Paris, France
| | - Sophie Alami
- Cabinet d'Études Sociologiques Interlis, Paris, France
| | - Katherine Sanchez
- AP-HP.Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France
| | - Camille Daste
- UFR de Médecine, Faculté de Santé, Université de Paris, Paris, France.,AP-HP.Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France.,INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique, ECaMO Team, Paris, France
| | - Margaux Boisson
- AP-HP.Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France
| | | | - Peggy Krief
- Department Health Work Environment, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Epalinges-Lausanne, Switzerland
| | - Guillaume Krief
- School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Marie-Martine Lefèvre-Colau
- UFR de Médecine, Faculté de Santé, Université de Paris, Paris, France.,AP-HP.Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France.,INSERM UMR-S 1153, Centre de Recherche Épidémiologie et Statistique, ECaMO Team, Paris, France.,Institut Fédératif de Recherche sur le Handicap, Paris, France
| | - François Rannou
- UFR de Médecine, Faculté de Santé, Université de Paris, Paris, France.,AP-HP.Centre-Université de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Paris, France.,INSERM UMRS-1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Paris, France
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Gevers-Montoro C, Provencher B, Descarreaux M, Ortega de Mues A, Piché M. Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain. Eur J Pain 2021; 25:1429-1448. [PMID: 33786932 DOI: 10.1002/ejp.1773] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/05/2021] [Accepted: 03/27/2021] [Indexed: 12/19/2022]
Abstract
Together, neck pain and back pain are the first cause of disability worldwide, accounting for more than 10% of the total years lived with disability. In this context, chiropractic care provides a safe and effective option for the management of a large proportion of these patients. Chiropractic is a healthcare profession mainly focused on the spine and the treatment of spinal disorders, including spine pain. Basic studies have examined the influence of chiropractic spinal manipulation (SM) on a variety of peripheral, spinal and supraspinal mechanisms involved in spine pain. While spinal cord mechanisms of pain inhibition contribute at least partly to the pain-relieving effects of chiropractic treatments, the evidence is weaker regarding peripheral and supraspinal mechanisms, which are important components of acute and chronic pain. This narrative review highlights the most relevant mechanisms of pain relief by SM and provides a perspective for future research on SM and spine pain, including the validation of placebo interventions that control for placebo effects and other non-specific effects that may be induced by SM. SIGNIFICANCE: Spinal manipulation inhibits back and neck pain partly through spinal segmental mechanisms and potentially through peripheral mechanisms regulating inflammatory responses. Other mechanisms remain to be clarified. Controls and placebo interventions need to be improved in order to clarify the contribution of specific and non-specific effects to pain relief by spinal manipulative therapy.
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Affiliation(s)
- Carlos Gevers-Montoro
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,Madrid College of Chiropractic - RCU María Cristina, Madrid, Spain
| | - Benjamin Provencher
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Martin Descarreaux
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,GRAN Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | - Mathieu Piché
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.,CogNAC Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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9
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Abstract
OBJECTIVE To investigate the relationship between changes in volitional spinal movement (including muscle activity) and changes in pain or activity limitation at the individual level in people with nonspecific low back pain. DESIGN Etiology systematic review. LITERATURE SEARCH MEDLINE, Embase, CINAHL, and AMED were searched from inception to January 2020. STUDY SELECTION CRITERIA The study included peer-reviewed articles that reported the relationship between changes in volitional spinal movement and changes in pain or activity limitation at the individual level in people with nonspecific low back pain. DATA SYNTHESIS The data were descriptively synthesized to identify a relationship between change in movement and improved pain or activity limitation. RESULTS We included 27 studies involving 2739 participants. There was low-quality evidence of a relationship between change in movement and change in pain or activity limitation at the individual level 31% of the time (20 of the 65 times investigated within the 27 studies). Increases in spinal range of motion, velocity, and flexion relaxation of the back extensors were consistently related to improved pain or activity limitation (93%, 18.5/20 relationships observed). CONCLUSION A relationship between changes in movement and changes in pain or activity limitation was infrequently observed at the individual level; however, a paucity of high-quality evidence precludes a definitive understanding of this relationship. J Orthop Sports Phys Ther 2020;50(12):664-680. Epub 28 Oct 2020. doi:10.2519/jospt.2020.9635.
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10
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Muresanu C, Somasundaram SG, Neganova ME, Bovina EV, Vissarionov SV, Ofodile ONFC, Fisenko VP, Bragin V, Minyaeva NN, Chubarev VN, Klochkov SG, Tarasov VV, Mikhaleva LM, Kirkland CE, Aliev G. Updated Understanding of the Degenerative Disc Diseases - Causes Versus Effects - Treatments, Studies and Hypothesis. Curr Genomics 2020; 21:464-477. [PMID: 33093808 PMCID: PMC7536794 DOI: 10.2174/1389202921999200407082315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/20/2019] [Accepted: 03/16/2020] [Indexed: 01/22/2023] Open
Abstract
Background In this review we survey medical treatments and research strategies, and we discuss why they have failed to cure degenerative disc diseases or even slow down the degenerative process. Objective We seek to stimulate discussion with respect to changing the medical paradigm associated with treatments and research applied to degenerative disc diseases. Method Proposal We summarize a Biological Transformation therapy for curing chronic inflammations and degenerative disc diseases, as was previously described in the book Biological Transformations controlled by the Mind Volume 1. Preliminary Studies A single-patient case study is presented that documents complete recovery from an advanced lumbar bilateral discopathy and long-term hypertrophic chronic rhinitis by application of the method proposed. Conclusion Biological transformations controlled by the mind can be applied by men and women in order to improve their quality of life and cure degenerative disc diseases and chronic inflammations illnesses.
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Affiliation(s)
- Cristian Muresanu
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Siva G Somasundaram
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Margarita E Neganova
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Elena V Bovina
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Sergey V Vissarionov
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Okom N F C Ofodile
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Vladimir P Fisenko
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Valentin Bragin
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Nina N Minyaeva
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Vladimir N Chubarev
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Sergey G Klochkov
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Vadim V Tarasov
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Liudmila M Mikhaleva
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Cecil E Kirkland
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
| | - Gjumrakch Aliev
- 1Romanian Television, TVR Cluj, 160 Donath Street, Cluj-Napoca, CJ 400293, Romania; 2Department of Biological Sciences, Salem University, Salem, WV, USA; 3Institute of Physiologically Active Compounds Russian Academy of Sciences, Chernogolovka, 142432, Russia; 4Department of Spinal Pathology and Neurosurgery, Turner Scientific and Research Institute for Children's Orthopedics, Street Parkovskya 64-68, Pushkin, Saint-Petersburg, 196603, Russia; 5Center for Cardiovascular Research (CCR), Institute of Pharmacology, Charite, Universitaetsmedizin Berlin, AG: Theuring, Hessische Strasse 2-4, D-10115Berlin, Germany, 6Obie-Medical Corporate International LTD., Academic Section, 28 Oranye Street (American Quarters), Onitsha, Anambra State, Nigeria; 7I. M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8, Bld. 2, Moscow, 119991, Russia; 8Stress Relief and Memory Training Center, 3101 Ocean Pkwy, Suite 1A, Brooklyn, NY, 11235, USA; 9National Research University Higher School of Economics, 20 Myasnitskaya Street, Moscow, 101000, Russia; 10Research Institute of Human Morphology, 3, Tsyurupy Str., Moscow, 117418, Russia; 11GALLY International Research Institute, 7733 Louis Pasteur Drive, #330, San Antonio, TX78229, USA
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Psychological context effects of participant expectation on pain pressure thresholds as an adjunct to cervicothoracic HVLA thrust manipulation: A randomised controlled trial. INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Bishop MD, Bialosky JE, Alappattu MJ. Riding a Tiger: Maximizing Effects of Manual Therapies for Pelvic Pain. JOURNAL OF WOMEN'S HEALTH PHYSICAL THERAPY 2020; 44:32-38. [PMID: 34163308 PMCID: PMC8218714 DOI: 10.1097/jwh.0000000000000156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Manual therapy interventions are frequently used during the management of pelvic pain conditions. Pain relief after any intervention results from effects unrelated to the intervention, effects specific to the intervention, and effects of context in which the intervention is provided. Understanding these multiple mechanisms allows providers of manual therapy to maximize outcomes by deliberately harnessing each of these core elements of pain relief.
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Affiliation(s)
- Mark D. Bishop
- Department of Physical Therapy, University of Florida, Gainesville
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville
| | - Joel E. Bialosky
- Department of Physical Therapy, University of Florida, Gainesville
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville
- Brooks-PHHP Research Collaboration, Jacksonville, Florida
| | - Meryl J. Alappattu
- Department of Physical Therapy, University of Florida, Gainesville
- Center for Pain Research and Behavioral Health, University of Florida, Gainesville
- Brooks-PHHP Research Collaboration, Jacksonville, Florida
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13
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Khodadad B, Letafatkar A, Hadadnezhad M, Shojaedin S. Comparing the Effectiveness of Cognitive Functional Treatment and Lumbar Stabilization Treatment on Pain and Movement Control in Patients With Low Back Pain. Sports Health 2019; 12:289-295. [PMID: 31841078 DOI: 10.1177/1941738119886854] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The treatment of chronic low back pain (LBP) should target both behavioral variables and physical performance factors. HYPOTHESIS Cognitive functional treatment (CFT) and lumbar stabilization treatment (LST) will result in positive changes in pain and lumbar movement control (LMC) in patients with LBP. STUDY DESIGN Pretest-posttest intervention. LEVEL OF EVIDENCE Level 3. METHODS After screening, 52 participants (mean age, 44.3 ± 2.46 years) with chronic LBP were allocated into CFT (n = 17), LST (n = 17), or control (n = 18) groups. Pain and LMC were evaluated before and after 8 weeks of intervention with visual analog scale (VAS) and Luomajoki LMC battery tests, respectively. RESULTS Compared with baseline, pain and LMC were reduced and improved significantly in both groups after 8 weeks. However, the changes in both variables were not significantly different between groups. Percent change for pain between pretest and posttest values in the LST group was a decrease of 45% (P = 0.003), compared with a decrease of 40% (P = 0.003) in the CFT group. Change in LMC in the LST group was a decrease of 100% (P = 0.026), compared with a decrease of 200% (P = 0.018) in the CFT group. There as no change for both variables in the control group. CONCLUSION Both CFT and LST groups improved LMC scores and reduced pain intensity. However, there was no difference between the 2 experimental groups on pain and LMC test results. CLINICAL RELEVANCE In this study, intended to construct an intervention for people with chronic LBP, the primary aims were to help individuals "make sense of their pain," develop effective pain control strategies via body relaxation and extinction of safety behaviors, and adopt healthy lifestyle behaviors to affect cognitive factors known to affect pain sensitivity and disability. These primary aims were achieved through an emphasis on factors such as development of positive beliefs, reduced fear, increased awareness, enhanced understanding and control of pain, adaptive coping, enhanced self-efficacy, confidence, and improved mood through the class-based intervention.
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Affiliation(s)
- Behrouz Khodadad
- Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Republic of Iran
| | - Amir Letafatkar
- Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Republic of Iran
| | - Malihe Hadadnezhad
- Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Republic of Iran
| | - Sadredin Shojaedin
- Faculty of Physical Education and Sport Sciences, Department of Biomechanics and Sport Injuries, Kharazmi University, Tehran, Republic of Iran
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14
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Escriche-Escuder A, Calatayud J, Aiguadé R, Andersen LL, Ezzatvar Y, Casaña J. Core Muscle Activity Assessed by Electromyography During Exercises for Chronic Low Back Pain: A Systematic Review. Strength Cond J 2019. [DOI: 10.1519/ssc.0000000000000456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Use of manual therapies in the treatment of posterior pelvic pain is a common practice. The rationale for use of manual therapies is often associated with the structural movement of the sacroiliac joint. Increasing evidence has shown this not to be the case, as manual therapy's effect is more neurophysiological in nature. This article seeks to clarify the difference between the two explanations as well as to expand upon outside influences such as expectations, therapeutic alliance, and equipoise that may influence the outcome of treatment. Treatment effects may be maximized with manual therapy if clinicians have an understanding of the role of each of these variables in their treatment approach.
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Affiliation(s)
- Derek Miles
- Department of Rehabilitation, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA
| | - Mark Bishop
- Department of Physical Therapy, Center for Pain Research and Behavioral Health, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL
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Eaves ER, Hsu CW, DeBar LL, Livingston CJ, Ocker LE, McDonald SJ, Dillon-Sumner L, Ritenbaugh C. Whole Systems Within Whole Systems: The Oregon Health Plan's Expansion of Services for Back and Neck Pain. J Altern Complement Med 2019; 25:S61-S68. [PMID: 30870022 DOI: 10.1089/acm.2018.0431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The authors employ a Whole Systems framework to explore implementation of new guidelines for back and neck pain in Oregon's Medicaid system. Whole Systems research is useful for understanding the relationship between complementary and integrative health care (CIH) and conventional health care systems in real-world clinical and practice settings. DESIGN Preliminary results are from an observational study designed to evaluate state-wide implementation of CIH and other non-pharmacological treatments for neck and back pain among Oregon Medicaid patients. This natural experiment, even in early stages, provides insight into the challenges of integrating Whole Systems oriented therapies into Medicaid billing and treatment. METHODS Qualitative data are drawn from: (1) semi-structured interviews with representatives of each of the 16 coordinated care organizations (CCOs) responsible for administering the Oregon's Medicaid insurance through the Oregon Health Plan (OHP); and (2) open-ended survey responses from acupuncturists in all 16 CCO areas. RESULTS Implementation of the new policy guidelines poses logistical and epistemological challenges. Differences in worldview, inadequate reimbursement, and simple lack of awareness of CIH among medical providers are some of the factors that pose barriers to merging CIH therapies into conventional frameworks. CONCLUSIONS In this article, we explore the potential for a Whole Systems perspective to better explain the complexity of integrating CIH and other non-pharmacological services into a state financed health care system. Oregon's expansion of services for back and neck pain presents an opportunity to explore challenges and successes in melding multiple approaches to health and pain management into a managed system such as the OHP.
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Affiliation(s)
- Emery R Eaves
- 1 Department of Anthropology, Northern Arizona University, Flagstaff, AZ
| | - Clarissa W Hsu
- 2 Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Lynn L DeBar
- 2 Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | | | - Sarah J McDonald
- 2 Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | | | - Cheryl Ritenbaugh
- 5 Department of Family and Community Medicine, University of Arizona, Tucson, AZ
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Rossettini G, Carlino E, Testa M. Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain. BMC Musculoskelet Disord 2018; 19:27. [PMID: 29357856 PMCID: PMC5778801 DOI: 10.1186/s12891-018-1943-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/15/2018] [Indexed: 12/18/2022] Open
Abstract
Placebo and nocebo effects are embodied psycho-neurobiological responses capable of modulating pain and producing changes at different neurobiological, body at perceptual and cognitive levels. These modifications are triggered by different contextual factors (CFs) presented in the therapeutic encounter between patient and healthcare providers, such as healing rituals and signs. The CFs directly impact on the quality of the therapeutic outcome: a positive context, that is a context characterized by the presence of positive CFs, can reduce pain by producing placebo effects, while a negative context, characterized by the presence of negative CFs, can aggravate pain by creating nocebo effects. Despite the increasing interest about this topic; the detailed study of CFs as triggers of placebo and nocebo effects is still lacked in the management of musculoskeletal pain. Increasing evidence suggest a relevant role of CFs in musculoskeletal pain management. CFs are a complex sets of internal, external or relational elements encompassing: patient’s expectation, history, baseline characteristics; clinician’s behavior, belief, verbal suggestions and therapeutic touch; positive therapeutic encounter, patient-centered approach and social learning; overt therapy, posology of intervention, modality of treatment administration; marketing features of treatment and health care setting. Different explanatory models such as classical conditioning and expectancy can explain how CFs trigger placebo and nocebo effects. CFs act through specific neural networks and neurotransmitters that were described as mediators of placebo and nocebo effects. Available findings suggest a relevant clinical role and impact of CFs. They should be integrated in the clinical reasoning to increase the number of treatment solutions, boosts their efficacy and improve the quality of the decision-making. From a clinical perspective, the mindful manipulation of CFs represents a useful opportunity to enrich a well-established therapy in therapeutic setting within the ethical border. From a translational perspective, there is a strong need of research studies on CFs close to routine and real-world clinical practice in order to underline the uncertainty of therapy action and help clinicians to implement knowledge in daily practice.
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona. Via Magliotto, 2, 17100, Savona, Italy
| | - Elisa Carlino
- Department of Neuroscience, University of Turin Medical School, Turin, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona. Via Magliotto, 2, 17100, Savona, Italy.
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Abstract
Synopsis Manual therapy interventions are popular among individual health care providers and their patients; however, systematic reviews do not strongly support their effectiveness. Small treatment effect sizes of manual therapy interventions may result from a "one-size-fits-all" approach to treatment. Mechanistic-based treatment approaches to manual therapy offer an intriguing alternative for identifying patients likely to respond to manual therapy. However, the current lack of knowledge of the mechanisms through which manual therapy interventions inhibit pain limits such an approach. The nature of manual therapy interventions further confounds such an approach, as the related mechanisms are likely a complex interaction of factors related to the patient, the provider, and the environment in which the intervention occurs. Therefore, a model to guide both study design and the interpretation of findings is necessary. We have previously proposed a model suggesting that the mechanical force from a manual therapy intervention results in systemic neurophysiological responses leading to pain inhibition. In this clinical commentary, we provide a narrative appraisal of the model and recommendations to advance the study of manual therapy mechanisms. J Orthop Sports Phys Ther 2018;48(1):8-18. doi:10.2519/jospt.2018.7476.
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DiMond ME. Rehabilitative Principles in the Management of Thoracolumbar Syndrome: A Case Report. J Chiropr Med 2017; 16:331-339. [PMID: 29276466 DOI: 10.1016/j.jcm.2017.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 01/07/2023] Open
Abstract
Objective The purpose of this case report was to describe the chiropractic management of thoracolumbar syndrome using multimodal therapies. Clinical Features A 33-year-old woman with 3 weeks of back pain presented to a chiropractic clinic. Nerve tension tests and local tenderness were present in a pattern described by Maigne, and she was diagnosed with thoracolumbar syndrome (Maigne syndrome) at her initial visit. Intervention and Outcomes The Oswestry Disability Index for low back pain (62%), STarT low back screen tool for clinical outcomes (6 points total, with a 2-point subscale), numeric pain rating scale (6/10 constant, 10/10 with provocation), and test-retest exercise audits were outcome measures. She received 3 treatment sessions, each with progressive exercise audits, and discharged with advice. At discharge, the patient scores substantially improved (Oswestry Disability Index: 8%, STarT: 1 point total, numeric pain rating scale: 1/10, 10% of the time), and she exhibited greater confidence in home care. Endurance tests were performed to establish baselines for future care, which included static back endurance test (timed 52 seconds) and side bridge endurance test (timed 43 seconds). Conclusion The patient responded positively to chiropractic care. After a short course of care, the patient reported reduced pain, alleviated symptoms, and improved physical function.
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Affiliation(s)
- Mathew E DiMond
- UB Clinics, University of Bridgeport, Bridgeport, Connecticut
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Menke JM, Ahsan MS, Khoo SP. More Accurate Oral Cancer Screening with Fewer Salivary Biomarkers. BIOMARKERS IN CANCER 2017; 9:1179299X17732007. [PMID: 29085239 PMCID: PMC5648090 DOI: 10.1177/1179299x17732007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 08/21/2017] [Indexed: 01/05/2023]
Abstract
Signal detection and Bayesian inferential tools were applied to salivary biomarkers to improve screening accuracy and efficiency in detecting oral squamous cell carcinoma (OSCC). Potential cancer biomarkers are identified by significant differences in assay concentrations, receiver operating characteristic areas under the curve (AUCs), sensitivity, and specificity. However, the end goal is to report to individual patients their risk of having disease given positive or negative test results. Likelihood ratios (LRs) and Bayes factors (BFs) estimate evidential support and compile biomarker information to optimize screening accuracy. In total, 26 of 77 biomarkers were mentioned as having been tested at least twice in 137 studies and published in 16 summary papers through 2014. Studies represented 10 212 OSCC and 25 645 healthy patients. The measure of biomarker and panel information value was number of biomarkers needed to approximate 100% positive predictive value (PPV). As few as 5 biomarkers could achieve nearly 100% PPV for a disease prevalence of 0.2% when biomarkers were ordered from highest to lowest LR. When sequentially interpreting biomarker tests, high specificity was more important than test sensitivity in achieving rapid convergence toward a high PPV. Biomarkers ranked from highest to lowest LR were more informative and easier to interpret than AUC or Youden index. The proposed method should be applied to more recently published biomarker data to test its screening value.
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Affiliation(s)
| | - Md Shahidul Ahsan
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, The University of Iowa, Iowa City, IA, USA
| | - Suan Phaik Khoo
- Department of Oral Diagnostic and Surgical Sciences, School of Dentistry, International Medical University (IMU), Kuala Lumpur, Malaysia
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Unsolved, Forgotten, and Ignored Features of the Placebo Response in Medicine. Clin Ther 2017; 39:458-468. [DOI: 10.1016/j.clinthera.2016.11.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 12/14/2022]
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Puhl AA, Reinhart CJ, Doan JB, Vernon H. The quality of placebos used in randomized, controlled trials of lumbar and pelvic joint thrust manipulation-a systematic review. Spine J 2017; 17:445-456. [PMID: 27888138 DOI: 10.1016/j.spinee.2016.11.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 10/25/2016] [Accepted: 11/09/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal manipulative therapy (SMT) has been attributed with substantial non-specific effects. Accurate assessment of the non-specific effects of SMT relies on high-quality studies with low risk of bias that compare with appropriate placebos. PURPOSE This review aims to characterize the types and qualities of placebo control procedures used in controlled trials of manually applied, lumbar and pelvic (LP)-SMT, and to evaluate the assessment of subject blinding and expectations. STUDY DESIGN This is a systematic review of randomized, placebo-controlled trials. METHODS We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Index to Chiropractic Literature, and relevant bibliographies. We included randomized, placebo or sham-controlled trials where the index treatment was manually applied LP-SMT. There were no restrictions on the type of condition being investigated. Two independent reviewers selected the studies, assessed study quality, and extracted the data. Relevant data were the type and quality of placebo control(s) used, the assessment of blinding and expectations, and the results of those assessments. RESULTS Twenty-five randomized, placebo-controlled trials were included in this review. There were 18 trials that used a sham manual SMT procedure for their placebo control intervention; the most common approach was with an SMT setup but without the application of any thrust. One small pilot study used an unequivocally indistinguishable placebo, two trials used placebos that had been validated as inert a priori, and eight trials reported on the success of subject blinding. Risk of bias was high or unclear, for all included studies. CONCLUSIONS Imperfect placebos are ubiquitous in clinical trials of LP-SMT, and few trials have assessed for successful subject blinding or balanced expectations of treatment success between active and control group subjects. There is thus a strong potential for unmasking of control subjects, unequal non-specific effects between active and control groups, and non-inert placebos in existing trials. Future trials should consider assessing the success of subject blinding and ensuring inertness of their placebo a priori, as a minimum standard for quality.
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Affiliation(s)
- Aaron A Puhl
- Private Practice, Able Body Health Clinic, 1212 - 3rd Ave South, Lethbridge, Alberta T1J 0J9, Canada.
| | - Christine J Reinhart
- Private Practice, Able Body Health Clinic, 1212 - 3rd Ave South, Lethbridge, Alberta T1J 0J9, Canada
| | - Jon B Doan
- Engineering and Human Performance Laboratory, Department of Kinesiology and Physical Education, University of Lethbridge, 4401 University Drive West, Lethbridge, Alberta, T1K 6T5, Canada
| | - Howard Vernon
- Division of Research, Canadian Memorial Chiropractic College, 6100 Leslie Street North York, Toronto, Ontario M2H 3J1, Canada
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Steel A, Sundberg T, Reid R, Ward L, Bishop FL, Leach M, Cramer H, Wardle J, Adams J. Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research. Musculoskelet Sci Pract 2017; 27:165-175. [PMID: 27852531 DOI: 10.1016/j.math.2016.10.067] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/25/2016] [Accepted: 10/27/2016] [Indexed: 12/30/2022]
Abstract
In recent years, evidence has emerged regarding the effectiveness of osteopathic manipulative treatments (OMT). Despite growing evidence in this field, there is need for appropriate research designs that effectively reflect the person-centred system of care promoted in osteopathy and provide data which can inform policy decisions within the healthcare system. The purpose of this systematic review is to identify, appraise and synthesise the evidence from comparative effectiveness and economic evaluation research involving OMT. A database search was conducted using CINAHL, PubMed, PEDro, AMED, SCOPUS and OSTMED.DR, from their inception to May 2015. Two separate searches were undertaken to identify original research articles encompassing the economic evaluation and comparative effectiveness of OMT. Identified comparative effectives studies were evaluated using the Cochrane risk of bias tool and appraised using the Good Reporting of Comparative Effectiveness (GRACE) principles. Identified economic studies were assessed with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Sixteen studies reporting the findings of comparative effectiveness (n = 9) and economic evaluation (n = 7) research were included. The comparative effectiveness studies reported outcomes for varied health conditions and the majority (n = 6) demonstrated a high risk of bias. The economic evaluations included a range of analyses and considerable differences in the quality of reporting were evident. Despite some positive findings, published comparative effectiveness and health economic studies in OMT are of insufficient quality and quantity to inform policy and practice. High quality, well-designed, research that aligns with international best practice is greatly needed to build a pragmatic evidence base for OMT.
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Affiliation(s)
- Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia.
| | - Tobias Sundberg
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Research Unit for Studies of Integrative Health Care, Karolinska Institutet (NVS/OMV), Alfred Nobels Alle 23, 141 83, Stockholm, Sweden
| | - Rebecca Reid
- Endeavour College of Natural Health, Level 2, 269 Wickham St, Fortitude Valley, QLD, 4006, Australia
| | - Lesley Ward
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), B4495, Oxford, OX3 7LD, University of Oxford, Oxford, United Kingdom
| | - Felicity L Bishop
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Centre for Applications of Health Psychology, Faculty of Social Human and Mathematical Sciences, Building 44 Highfield Campus, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Matthew Leach
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; School of Nursing & Midwifery, Health Economics & Social Policy Group, University of South Australia, 101 Currie St, Adelaide, Australia
| | - Holger Cramer
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia; Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, 45141, Duisburg, Germany
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia
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Abstract
Low back pain (LBP) is the leading cause of disability worldwide. Various approaches to diagnose and manage LBP have arisen, leading to an exponential increase in health care costs. Paradoxically, this trend has been associated with a concurrent increase in disability and chronicity. The health care system faces enormous challenges, with both the disability burden and financial impact relating to LBP escalating. Growing evidence suggests that current practice is discordant with contemporary evidence, and is in fact often exacerbating the problem. Change will demand a cultural shift in LBP beliefs and practice. J Orthop Sports Phys Ther 2016;46(11):932-937. doi:10.2519/jospt.2016.0609.
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O'Keeffe M, Hayes A, McCreesh K, Purtill H, O'Sullivan K. Are group-based and individual physiotherapy exercise programmes equally effective for musculoskeletal conditions? A systematic review and meta-analysis. Br J Sports Med 2016; 51:126-132. [DOI: 10.1136/bjsports-2015-095410] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 12/26/2022]
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Lumbar Thrust Manipulation and Exercise for the Treatment of Mechanical Low Back Pain in Adolescents: A Case Series. J Orthop Sports Phys Ther 2016; 46:391-8. [PMID: 27049600 DOI: 10.2519/jospt.2016.6366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Case series. Background Low back pain (LBP) is an increasing problem in health care. The evidence for the use of spinal manipulative therapy to treat pediatric patients with LBP is minimal. The treatment of pediatrics with manual therapy, particularly spinal manipulation, is controversial within the medical community, primarily with respect to adverse events. The purpose of this case series was to illustrate the feasibility and safety of lumbar manipulation plus exercise in the adolescent population with mechanical LBP. Case Description Three patients-a 13-year-old adolescent girl, 15-year-old adolescent girl, and 13-year-old adolescent boy-were treated in an outpatient physical therapy setting for mechanical LBP. All 3 patients were assessed using a lumbar manipulation clinical prediction rule and treated with sidelying lumbar manipulation and exercise. Outcomes Patients were treated for a total of 10 to 14 visits over a course of 8 to 9 weeks. Pain (measured by a numeric pain-rating scale) and disability (measured by the modified Oswestry Disability Index) improved to 0/10 and 0%, respectively, in each patient. No adverse reactions to manipulation were reported. Discussion The results of this case series describe the use of lumbar thrust manipulation and exercise for the treatment of mechanical LBP in adolescents. The positive results indicate that lumbar manipulation may be a safe adjunct therapy. Further studies, including randomized controlled trials, are needed to determine effectiveness. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2016;46(5):391-398. Epub 6 Apr 2016. doi:10.2519/jospt.2016.6366.
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Comparative Effectiveness of Conservative Interventions for Nonspecific Chronic Spinal Pain: Physical, Behavioral/Psychologically Informed, or Combined? A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2016; 17:755-74. [PMID: 26844416 DOI: 10.1016/j.jpain.2016.01.473] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 12/05/2015] [Accepted: 01/14/2016] [Indexed: 12/11/2022]
Abstract
UNLABELLED Nonspecific chronic spinal pain (NSCSP) is highly disabling. Current conservative rehabilitation commonly includes physical and behavioral interventions, or a combination of these approaches. Physical interventions aim to enhance physical capacity by using methods such as exercise, manual therapy, and ergonomics. Behavioral/psychologically informed interventions aim to enhance behaviors, cognitions, or mood by using methods such as relaxation and cognitive behavioral therapy. Combined interventions aim to target physical and also behavioral/psychological factors contributing to patients' pain by using methods such as multidisciplinary pain management programs. Because it remains unclear whether any of these approaches are superior, this review aimed to assess the comparative effectiveness of physical, behavioral/psychologically informed, and combined interventions on pain and disability in patients with NSCSP. Ten electronic databases were searched for randomized controlled trials (RCTs) including participants reporting NSCSP. Studies were required to have an "active" conservative treatment control group for comparison. Studies were not eligible if the interventions were from the same domain (eg, if the study compared 2 physical interventions). Study quality was assessed used the Cochrane Back Review Group risk of bias criteria. The treatment effects of physical, behavioral/psychologically informed, and combined interventions were assessed using meta-analyses. Twenty-four studies were included. No clinically significant differences were found for pain and disability between physical, behavioral/psychologically informed, and combined interventions. The simple categorization of interventions into physical, behavioral/psychologically informed, and combined could be considered a limitation of this review, because these interventions may not be easily differentiated to allow accurate comparisons to be made. Further work should consider investigating whether tailoring rehabilitation to individual patients and their perceived risk of chronicity, as seen in recent RCTs for low back pain, can enhance outcomes in NSCSP. PERSPECTIVE In this systematic review of RCTs in NSCSP, only small differences in pain or disability were observed between physical, behavioral/psychologically informed, and combined interventions.
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Clinical Practice Guideline: Chiropractic Care for Low Back Pain. J Manipulative Physiol Ther 2016; 39:1-22. [DOI: 10.1016/j.jmpt.2015.10.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/24/2015] [Accepted: 10/02/2015] [Indexed: 11/24/2022]
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Legge D. Acupuncture Treatment of Chronic Low Back Pain by Using the Jingjin (Meridian Sinews) Model. J Acupunct Meridian Stud 2015; 8:255-8. [PMID: 26433803 DOI: 10.1016/j.jams.2015.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/13/2015] [Accepted: 07/23/2015] [Indexed: 12/19/2022] Open
Abstract
This case report details the unexpected and sustained relief from chronic low back pain in a patient after a single acupuncture treatment. The treatment administered on that occasion was based on the jingjin (i.e., "meridian sinew") model of traditional acupuncture. Treatments based on the jingjin model involve needling the ah shi (i.e., locally tender) points in myofascial tissue along the jingjin pathway. Tight chains can be needled to treat symptoms that are either close to or at some distance from the site of the needling treatment. In this patient, the points were in the gastrocnemius muscle and the hamstring muscles, which are part of the Bladder jingjin pathway. The patient, a 69-year-old woman, had had back pain for more than 40 years. The relief from the pain occurred within a day after the treatment and, at the time of this report, the relief has persisted for 5 months. This report examines two possible mechanisms for such a result: (1) a local increase in the extensibility of the hamstrings could be responsible or (2) the complex interactions within the central nervous system that are involved in acupuncture treatment could be more important factors.
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Affiliation(s)
- David Legge
- School of Science and Health, University of Western Sydney, Sydney, Australia.
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Menke JM. Deconstructing the Tower of Back Pain Babel. PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x15y.0000000018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Letters. Spine (Phila Pa 1976) 2015; 40:E856-8. [PMID: 26164162 DOI: 10.1097/brs.0000000000000978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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O'Keeffe M, Purtill H, Kennedy N, O'Sullivan P, Dankaerts W, Tighe A, Allworthy L, Dolan L, Bargary N, O'Sullivan K. Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: study protocol for a multicentre randomised controlled trial. BMJ Open 2015; 5:e007156. [PMID: 26033941 PMCID: PMC4458611 DOI: 10.1136/bmjopen-2014-007156] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 04/08/2015] [Accepted: 04/10/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Non-specific chronic low back pain (NSCLBP) is a very common and costly musculoskeletal disorder associated with a complex interplay of biopsychosocial factors. Cognitive functional therapy (CFT) represents a novel, patient-centred intervention which directly challenges pain-related behaviours in a cognitively integrated, functionally specific and graduated manner. CFT aims to target all biopsychosocial factors that are deemed to be barriers to recovery for an individual patient with NSCLBP. A recent randomised controlled trial (RCT) demonstrated the superiority of individualised CFT for NSCLBP compared to manual therapy combined with exercise. However, several previous RCTs have suggested that class-based interventions are as effective as individualised interventions. Therefore, it is important to examine whether an individualised intervention, such as CFT, demonstrates clinical effectiveness compared to a relatively cheaper exercise and education class. The current study will compare the clinical effectiveness of individualised CFT with a combined exercise and pain education class in people with NSCLBP. METHODS AND ANALYSIS This study is a multicentre RCT. 214 participants, aged 18-75 years, with NSCLBP for at least 6 months will be randomised to one of two interventions across three sites. The experimental group will receive individualised CFT and the length of the intervention will be varied in a pragmatic manner based on the clinical progression of participants. The control group will attend six classes which will be provided over a period of 6-8 weeks. Participants will be assessed preintervention, postintervention and after 6 and 12 months. The primary outcomes will be functional disability and pain intensity. Non-specific predictors, moderators and mediators of outcome will also be analysed. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Mayo General Hospital Research Ethics Committee (MGH-14-UL). Outcomes will be disseminated through publication according to the SPIRIT statement and will be presented at scientific conferences. TRIAL REGISTRATION NUMBER (ClinicalTrials.gov NCT02145728).
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Affiliation(s)
- Mary O'Keeffe
- Department of Clinical Therapies, University of Limerick, Limerick, Munster, Ireland
| | - Helen Purtill
- Department of Mathematics and Statistics, University of Limerick, Limerick, Munster, Ireland
| | - Norelee Kennedy
- Department of Clinical Therapies, University of Limerick, Limerick, Munster, Ireland
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia
| | - Wim Dankaerts
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences and Physiotherapy, University of Leuven, Leuven, Belgium
| | - Aidan Tighe
- Ballina Primary Care Centre, Ballina, Mayo, Ireland
| | - Lars Allworthy
- Physiotherapy Department, Mayo General Hospital, Castlebar, Mayo, Ireland
| | - Louise Dolan
- Claremorris Primary Care Centre, Claremorris, Mayo, Ireland
| | - Norma Bargary
- Department of Mathematics and Statistics, University of Limerick, Limerick, Munster, Ireland
| | - Kieran O'Sullivan
- Department of Clinical Therapies, University of Limerick, Limerick, Munster, Ireland
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Gagnon DH, Longtin C, Berbiche D, Gaudreault N. Do experienced physiotherapists and final year physiotherapy trainees apply similar force during posterior-to-anterior lumbar mobilization techniques? ACTA ACUST UNITED AC 2015; 21:287-91. [PMID: 26033263 DOI: 10.1016/j.math.2015.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 05/04/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
This study aims to quantify the force applied during posterior-to-anterior lumbar vertebrae mobilizations of different grades (I to IV) and compare that force between experienced physiotherapists and final year physiotherapy students. Four experienced physiotherapists and four final year physiotherapy students participated in this study along with five healthy asymptomatic individuals. A manual therapy table positioned over three force plates allowed for measurements of the force oscillation frequency and intensity applied during grade I, II, III and IV posterior-to-anterior (PA) mobilizations at two lumbar vertebral levels (L2 and L4). Mixed model ANOVAs were used to compare the force applied between the experienced physiotherapists and students, and between the various grades. The results showed that the mean oscillation frequency was similar between the groups for all grades. Grade I and grade IV PA mobilizations showed similar mean oscillation frequency as did grade II and III PA mobilizations. The minimum and maximum force applied was higher for the physiotherapists than for the students for all mobilization grades (p values < 0.05). Similar mean maximum force values were recorded for PA mobilizations between grade I and II and between grade III and grade IV. Grade III and IV PA mobilizations yielded higher mean maximum force values than those recorded during grade I and grade II PA mobilizations. The method used in this study allowed for quantification of the force applied during lumbar PA mobilizations. Experienced physiotherapists apply greater force than physiotherapy students across all grades, despite similar oscillation frequency.
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Affiliation(s)
- Dany H Gagnon
- School of Rehabilitation, Université de Montréal, Montreal, Canada; Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut de réadaptation Gingras-Lindsay-de-Montréal, Montreal, Canada.
| | - Christian Longtin
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada.
| | - Djamal Berbiche
- Centre de recherche, Hôpital Charles LeMoyne, Longueuil, Canada.
| | - Nathaly Gaudreault
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada; Centre de recherche, Hôpital Charles LeMoyne, Longueuil, Canada.
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Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: a randomized clinical trial. Spine (Phila Pa 1976) 2015; 40:209-17. [PMID: 25423308 PMCID: PMC4326596 DOI: 10.1097/brs.0000000000000724] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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. CONCLUSION MTM provides greater short-term reductions in self-reported disability and pain scores compared with UMC or MAM. LEVEL OF EVIDENCE 2.
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