Spinal High-Velocity Low Amplitude Manipulation in Acute Nonspecific Low Back Pain
- 1 April 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Spine
- Vol. 38 (7), 540-548
- https://doi.org/10.1097/brs.0b013e318275d09c
Abstract
A randomized, double-blinded, placebo-controlled, parallel trial with 3 arms. To investigate in acute nonspecific low back pain (LBP) the effectiveness of spinal high-velocity low-amplitude (HVLA) manipulation compared with the nonsteroidal anti-inflammatory drug diclofenac and with placebo. LBP is an important economical factor in all industrialized countries. Few studies have evaluated the effectiveness of spinal manipulation in comparison to nonsteroidal anti-inflammatory drugs or placebo regarding satisfaction and function of the patient, off-work time, and rescue medication. A total of 101 patients with acute LBP (for <48 hr) were recruited from 5 outpatient practices, exclusion criteria were numerous and strict. The subjects were randomized to 3 groups: (1) spinal manipulation and placebo-diclofenac; (2) sham manipulation and diclofenac; (3) sham manipulation and placebo-diclofenac. Outcomes registered by a second and blinded investigator included self-rated physical disability, function (SF-12), off-work time, and rescue medication between baseline and 12 weeks after randomization. Thirty-seven subjects received spinal manipulation, 38 diclofenac, and 25 no active treatment. The placebo group with a high number of dropouts for unsustainable pain was closed praecox. Comparing the 2 active arms with the placebo group the intervention groups were significantly superior to the control group. Ninety subjects were analyzed in the collective intention to treat. Comparing the 2 intervention groups, the manipulation group was significantly better than the diclofenac group (Mann-Whitney test: P = 0.0134). No adverse effects or harm was registered. In a subgroup of patients with acute nonspecific LBP, spinal manipulation was significantly better than nonsteroidal anti-inflammatory drug diclofenac and clinically superior to placebo.Keywords
This publication has 21 references indexed in Scilit:
- High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical InterventionsAnnals of Internal Medicine, 2011
- Expenditures and Health Status Among Adults With Back and Neck ProblemsJAMA, 2008
- Back Pain in the German Adult PopulationSpine, 2007
- Comorbidity of low back pain: Representative outcomes of a national health study in the Federal Republic of GermanyEuropean Journal of Pain Supplements, 2007
- Back Pain Prevalence and Visit RatesSpine, 2006
- Comorbid Subjective Health Complaints in Low Back PainSpine, 2006
- Comorbidity With Low Back PainSpine, 2004
- Estimates and Patterns of Direct Health Care Expenditures Among Individuals With Back Pain in the United StatesSpine, 2004
- Lost Productive Time and Cost Due to Common Pain Conditions in the US WorkforceJAMA, 2003
- Is low back pain part of a general health pattern or is it a separate and distinctive entity? A critical literature review of comorbidity with low back painJournal of Manipulative and Physiological Therapeutics, 2003