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Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain – Chiropractic Care
23 July 2024

Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain – Chiropractic Care

Comparison of Spinal Manipulation Methods

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. Manual-thrust manipulation (MTM) is a common treatment for low back pain (LBP). Claims that mechanical-assisted manipulation (MAM) is an effective alternative to manual-thrust manipulation (MTM) have yet to be substantiated. There is also question about the effectiveness of manipulation in acute and subacute low back pain (LBP) compared with usual medical care (UMC).

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.

Manual-thrust manipulation (MTM) provides greater short-term reductions in self-reported disability and pain scores compared with usual medical care (UMC) or mechanical-assisted manipulation (MAM).

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