Population: Patients 18 years or older with low back pain duration of 3 weeks or less. No neurologic component including sciatica.
Intervention: Spinal mobilization or manipulation grades I - V as defined by Maitland.
Comparison: Any comparison group used in a typical clinical setting with a follow-up of at least 24 hours.
Outcomes: Primary outcomes include short-term (follow-up of at least 24 hours to 3 months) pain and function as measured by the Roland-Morris Disability Questionnaire and the Visual Analogue Scale.
Clinical Scenario: A recent study of patient expectations for their treatment shows that patients expect first and foremost a clear diagnosis or a specific cause of their low back pain (Verbeek, et al. 2004). Secondly, patients expect a reduction in their back pain. In looking at acute low back pain there are many viable treatment options. Low back pain has been treated by everything from manual therapy to interferential electrical stimulation to back school or a back book. Patients coming to our clinics are there for relief of their symptoms so that they can return to their normal functional level. It is our job as clinicians to provide the best and most effective care possible. In doing so, we need to understand the benefits of and when it is appropriate to use each treatment method. Our study was designed to answer the question, "Is manual therapy significantly better at reducing short-term reports of pain and improving short-term function in patients suffering from acute low back pain?"
Clinical Bottom Line: Results from our research show manual therapy, in the form of spinal mobilization or manipulation, is equally as effective as other conventional therapies in the treatment of acute low back pain. According to our outcome measures, manual therapy techniques are no more effective in the short-term reduction of pain or short-term return of function in this patient population. Promise has been shown in the area of using a clinical prediction rule in order to identify specific patients who are most likely to see a significant difference in their function when being treated with manual therapy. Future research needs to address this avenue of patient care and determine whether or not there truly is a specific patient presentation more suited for manual therapy. At this point we can only say manual therapy serves as yet another viable option in the treatment of acute low back pain.
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