Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Mar-Apr;33(3):193-200.
doi: 10.1016/j.jmpt.2010.01.010.

Mechanical vs manual manipulation for low back pain: an observational cohort study

Michael J Schneider  1 , Jennifer Brach, James J Irrgang, Katherine Verdolini Abbott, Stephen R Wisniewski, Anthony Delitto
Affiliations

Mechanical vs manual manipulation for low back pain: an observational cohort study

Michael J Schneider et al. J Manipulative Physiol Ther. 2010 Mar-Apr.

Abstract

Objective: This is an observational prospective cohort study to explore the treatment effect of mechanical vs manual manipulation for acute low back pain.

Methods: Ninety-two patients with a history of acute low back pain were recruited from 3 private chiropractic offices, 2 of which used manual lumbar manipulation and 1 used mechanical instrument manipulation (Activator) as their primary modes of treatment. The chiropractors used their "treatment-as-usual" protocols for a maximum of 8 visits or 4 weeks, whichever occurred first. Primary outcome measures were changes in Numeric Pain Rating Scale (NPRS) and Oswestry Disability Index (ODI) scores from baseline to 4 weeks. The linear regression models were adjusted for baseline NPRS and ODI scores, age, and treatment expectancy.

Results: Comparison of baseline characteristics did not show any significant differences between the groups except for age (38.4 vs 49.7 years, P < .001) and treatment expectancy (5.7 vs 6.3, P = .003). Linear regression revealed significantly lower NPRS scores in the manual manipulation group at 4 weeks (beta = -1.2; 95% confidence interval, -2.1 to -.28) but no significant difference in ODI scores between the 2 groups at 4 weeks (beta = 1.5; 95% confidence interval, -8.3 to 2.4). Treatment expectancy, but not age, was found to have a significant main effect on both NPRS and ODI scores at 4 weeks. Exploratory analysis of the clinical patterns of care between the clinicians revealed significant differences in treatment frequency, duration, modality, and radiograph use between the 2 cohorts.

Conclusions: This study highlights the challenges inherent with conducting research that allows for "treatment as usual." The data and experience derived from this investigational study will be used to design a future randomized clinical trial in which tighter controls will be imposed on the treatment protocol.

PubMed Disclaimer

Conflict of interest statement

FUNDING SOURCES AND CONFLICTS OF INTEREST

Dr. Schneider completed this study while receiving salary support under a grant from the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) NIH/NCCAM Grant #: K99 A T004196-01. No conflicts of interest were reported for this study.

Figures

Figure 1
Figure 1
Baseline and 4-week unadjusted mean Numeric Pain Rating Scores (NPRS) by cohort. Regression analysis revealed that a significant difference in the mean adjusted 4-week pain scores remained after controlling for baseline pain, cohort, and expectation.
Figure 2
Figure 2
Baseline and four-week unadjusted mean Oswestry Disability Index (ODI) scores by cohort. Regression analysis did not reveal any significant difference in mean four-week ODI scores after controlling for baseline ODI.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bigos S, Bowyer O, Braen G. Agency for Health Care Polilcy and Research PHS, U.S. Dept. of Health and Human Services, editor. Rockville, MD: 1994. Acute Low Back Problems in Adults. Clinical Practice Guideline No. 14.
    1. Cunningham LS, Kelsey JL. Epidemiology of musculoskeletal impairments and associated disability. Am J Public Health. 1984;74:574–579. - PMC - PubMed
    1. Walker BF, Muller R, Grant WD. Low back pain in Australian adults: prevalence and associated disability. J Manipulative Physiol Ther. 2004;27(4):238–244. - PubMed
    1. Hestbaek L, Leboeuf-Yde C, Engberg M, Lauritzen T, Bruun NH, Manniche C. The course of low back pain in a general population. Results from a 5-year prospective study. J Manipulative Physiol Ther. 2003;26(4):213–219. - PubMed
    1. Bigos S, Bowyer O, Braen G. Clinical Practice Guideline No. 14. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Dept. of Health and Human Services; 1994. Acute Low Back Problems in Adults.

Publication types