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Physiother Can. 2014 Fall;66(4):359-66. doi: 10.3138/ptc.2013-49.

No Differences in Outcomes in People with Low Back Pain Who Met the Clinical Prediction Rule for Lumbar Spine Manipulation When a Pragmatic Non-thrust Manipulation Was Used as the Comparator.

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Youngstown State University, Youngstown, Oh.
Maitland-Australian Physiotherapy Seminars, Cutchogue, N.Y.
Pain Relief and Physical Therapy, Havertown, Pa.
Walsh University, North Canton, Oh, USA.


in English, French


To investigate differences in pain and disability between patients treated with thrust manipulation (TM) and those treated with non-thrust manipulation (NTM) in a group of patients with mechanical low back pain (LBP) who had a within-session response to an initial assessment and met the clinical prediction rule (CPR).


Data from 71 patients who met the CPR were extracted from a database of patients in a larger randomized controlled trial comparing TM and NTM. Treatment of the first two visits involved either TM or NTM (depending on allocation) and a standardized home exercise programme. Data analysis included descriptive statistics and a two-way ANOVA examining within- and between-groups effects for pain and disability, as well as total visits, total days in care, and rate of recovery.


No between-group differences in pain or disability were found for NTM versus TM groups (p=0.55), but within-subjects effects were noted for both groups (p<0.001).


This secondary analysis suggests that patients who satisfy the CPR benefit as much from NTM as from TM.


decision support techniques; low back pain; manipulation, spinal

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