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Randomized Controlled Trial
. 2019 May 15:27:21.
doi: 10.1186/s12998-019-0243-1. eCollection 2019.

Spinal manipulative therapy and exercise for older adults with chronic low back pain: a randomized clinical trial

Craig Schulz  1 , Roni Evans  1 , Michele Maiers  2 , Karen Schulz  3 , Brent Leininger  1 , Gert Bronfort  1
Affiliations
Randomized Controlled Trial

Spinal manipulative therapy and exercise for older adults with chronic low back pain: a randomized clinical trial

Craig Schulz et al. Chiropr Man Therap. .

Abstract

Background: Low back pain (LBP) is a common disabling condition in older adults which often limits physical function and diminishes quality of life. Two clinical trials in older adults have shown spinal manipulative therapy (SMT) results in similar or small improvements relative to medical care; however, the effectiveness of adding SMT or rehabilitative exercise to home exercise is unclear.

Methods: We conducted a randomized clinical trial assessing the comparative effectiveness of adding SMT or supervised rehabilitative exercise to home exercise in adults 65 or older with sub-acute or chronic LBP. Treatments were provided over 12-weeks and self-report outcomes were collected at 4, 12, 26, and 52 weeks. The primary outcome was pain severity. Secondary outcomes included back disability, health status, medication use, satisfaction with care, and global improvement. Linear mixed models were used to analyze outcomes. The primary analysis included longitudinal outcomes in the short (week 4-12) and long-term (week 4-52). An omnibus test assessing differences across all groups over the year was used to control for multiplicity. Secondary analyses included outcomes at each time point and responder analyses. This study was funded by the US Department of Health and Human Services, Health Resources and Services Administration.

Results: 241 participants were randomized and 230 (95%) provided complete primary outcome data. The primary analysis showed group differences in pain over the one-year were small and not statistically significant. Pain severity was reduced by 30 to 40% after treatment in all 3 groups with the largest difference (eight percentage points) favoring SMT and home exercise over home exercise alone. Group differences at other time points ranged from 0 to 6 percentage points with no consistent pattern favoring one treatment. One-year post-treatment pain reductions diminished in all three groups. Secondary self-report outcomes followed a similar pattern with no important group differences, except satisfaction with care, where the two combination groups were consistently superior to home exercise alone.

Conclusions: Adding spinal manipulation or supervised rehabilitative exercise to home exercise alone does not appear to improve pain or disability in the short- or long-term for older adults with chronic low back pain, but did enhance satisfaction with care.

Trial registration: NCT00269321.

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Conflict of interest statement

Ethical approval for the study was provided by the Institutional Review Boards at Northwestern Health Sciences University and the Minneapolis Medical Research Foundation. All participants provided written informed consent to participate.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow diagram. Lost to follow-up: participants who did not provide data at the specified time point and thereafter. HEP, home exercise program; SEP, supervised exercise program; SMT, spinal manipulative therapy
Fig. 2
Fig. 2
Change in mean pain severity over time. HEP, home exercise program; SEP, supervised exercise program; SMT, spinal manipulative therapy
Fig. 3
Fig. 3
Cumulative responder graphs—the y-axis displays the proportion of participants who reported a percent reduction in pain severity from baseline equal to or greater than the value on the x-axis. HEP, home exercise program; SEP, supervised exercise program; SMT, spinal manipulative therapy
See this image and copyright information in PMC

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