Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial

BMC Musculoskeletal Disorders

Olivier Dériaz⁴  Pierluigi Ballabeni²  Philippe Demeulenaere⁵  Gilles Rivier¹  Pierre de Goumoens³  Pierre Balthazard⁵ 

[1] Clinique Romande de Réadaptation SUVACare, Avenue Grand-Champsec, Sion, 1951, Switzerland;Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland;Centre Hospitalier Universitaire Vaudois (CHUV), Avenue Pierre Decker, Lausanne, 1011, Switzerland;Institut de Recherche en Réadaptation et Clinique Romande de Réadaptation SUVACare, Avenue Grand-Champsec, Sion, 1951, Switzerland;Physiotherapy Department, HES-SO University of Applied Sciences Western Switzerland, HESAV, Avenue de Beaumont, Lausanne, 1011, Switzerland

关键词: Disability;    Pain;    Active exercises;    Manual therapy;    Chronic non specific low back pain;   

Others  :  1145907
DOI  :  10.1186/1471-2474-13-162

 received in 2011-12-23, accepted in 2012-07-31,  发布年份 2012

【 摘 要 】

Background

Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations. Current evidences suggest that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels. The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE.

Methods

Forty-two CNSLBP patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus AE (MT group; n = 22), or detuned ultrasound (first intervention) plus AE (ST group; n = 20). Eight therapeutic sessions were delivered over 4 to 8 weeks. Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8^th therapeutic session, and at 3- and 6-month follow-ups.

Results

Thirty-seven subjects completed the study. MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session (VAS mean difference between interventions: -0.8; 95% CI: -1.2 to −0.3). Independently from time after treatment, MT + AE induced lower disability (ODI mean group difference: -7.1; 95% CI: -12.8 to −1.5) and a trend to lower pain (VAS mean group difference: -1.2; 95% CI: -2.4 to −0.30). Six months after treatment, Shirado test was better for the ST group (Shirado mean group difference: -61.6; 95% CI: -117.5 to −5.7). Insufficient evidence for group differences was found in remaining outcomes.

Conclusions

This study confirmed the immediate analgesic effect of MT over ST. Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP. Its neurophysiologic mechanisms at cortical level should be investigated more thoroughly.

Trial registration

Trial registration number: NCT01496144

【 授权许可】

   
2012 Balthazard et al.; licensee BioMed Central Ltd.

【 图 表 】

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