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Spine J. 2014 Jul 1;14(7):1106-16. doi: 10.1016/j.spinee.2013.07.468. Epub 2013 Oct 16.

Dose-response and efficacy of spinal manipulation for care of chronic low back pain: a randomized controlled trial.

Author information

1
Center for Outcomes Studies, University of Western States, 2700 NE 132nd Ave., Portland, OR 97230, USA. Electronic address: haasmitch@comcast.net.
2
Center for Outcomes Studies, University of Western States, 2700 NE 132nd Ave., Portland, OR 97230, USA.
3
Division of Chiropractic Sciences, University of Western States, 2700 NE 132nd Ave., Portland, OR 97230, USA.
4
The Mountain-Whisper-Light Statistics, 1827 23rd Ave. E., Seattle, WA 98122, USA.

Abstract

BACKGROUND CONTEXT:

There have been no full-scale trials of the optimal number of visits for the care of any condition with spinal manipulation.

PURPOSE:

To identify the dose-response relationship between visits to a chiropractor for spinal manipulation and chronic low back pain (cLBP) outcomes and to determine the efficacy of manipulation by comparison with a light massage control.

STUDY DESIGN/SETTING:

Practice-based randomized controlled trial.

PATIENT SAMPLE:

Four hundred participants with cLBP.

OUTCOME MEASURES:

The primary cLBP outcomes were the 100-point modified Von Korff pain intensity and functional disability scales evaluated at the 12- and 24-week primary end points. Secondary outcomes included days with pain and functional disability, pain unpleasantness, global perceived improvement, medication use, and general health status.

METHODS:

One hundred participants with cLBP were randomized to each of four dose levels of care: 0, 6, 12, or 18 sessions of spinal manipulation from a chiropractor. Participants were treated three times per week for 6 weeks. At sessions when manipulation was not assigned, they received a focused light massage control. Covariate-adjusted linear dose effects and comparisons with the no-manipulation control group were evaluated at 6, 12, 18, 24, 39, and 52 weeks.

RESULTS:

For the primary outcomes, mean pain and disability improvement in the manipulation groups were 20 points by 12 weeks and sustainable to 52 weeks. Linear dose-response effects were small, reaching about two points per six manipulation sessions at 12 and 52 weeks for both variables (p<.025). At 12 weeks, the greatest differences from the no-manipulation control were found for 12 sessions (8.6 pain and 7.6 disability points, p<.025); at 24 weeks, differences were negligible; and at 52 weeks, the greatest group differences were seen for 18 visits (5.9 pain and 8.8 disability points, p<.025).

CONCLUSIONS:

The number of spinal manipulation visits had modest effects on cLBP outcomes above those of 18 hands-on visits to a chiropractor. Overall, 12 visits yielded the most favorable results but was not well distinguished from other dose levels.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00376350.

KEYWORDS:

Chiropractic; Chronic low back pain; Dose-response; Randomized controlled trial; Spinal manipulation

PMID:
24139233
PMCID:
PMC3989479
DOI:
10.1016/j.spinee.2013.07.468
[Indexed for MEDLINE]
Free PMC Article
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