ABSTRACT:
Purpose and Study Design: Prospective cohort study to explore the clinical treatment effect of mechanical vs. manual manipulation for acute low back pain.
Methods: 92 patients with a history of acute low back pain were recruited from three private chiropractic offices. Two of these offices utilized manual lumbar manipulation and one used mechanical instrument manipulation (Activator) as their primary modes of treatment. The chiropractors used a treatment as usual protocol with the participants for a maximum of eight visits or four weeks, which ever occurred first. Primary and secondary outcome measures were the differences in pain and Oswestry scores from baseline to four weeks, respectively.
Results: Socio-demographic characteristics of the two cohorts at baseline were not found to show any significant differences between the groups except for age. The Activator cohort had a significantly higher utilization of adjunctive modalities and x-rays, with a mean number of office visits about twice that of the manual manipulation cohort at four weeks. The pain scores decreased in both groups with the manual manipulation group showing a slightly greater amount of pain reduction at four weeks, but this difference did not reach statistical significance after controlling for baseline pain. The manual manipulation group also showed a slightly greater reduction in Oswestry scores from baseline to four-weeks, but this difference was not statistically significant after adjusting for baseline Oswestry score.
Conclusions: In this observational study of treatment-as-usual there was no significantly greater reduction in pain scores or Oswestry scores between the manipulation and Activator groups at four weeks. There were many differences between the Activator and manual manipulation groups with respect to treatment beliefs and expectations, modality usage, and frequency/duration of care, which are potential sources of confounding in the interpretation of these results. This study provides important pilot data and research issues for the design of a future randomized clinical trial that can control for these issues of confounding variables.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-12022008-100352 |
| Date | 22 January 2009 |
| Creators | Schneider, Michael J |
| Contributors | Steven Wisniewski, Katherine Verdolini, Anthony Delitto, James Irrgang, Jennifer Brach |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-12022008-100352/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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