title: Trunk exercise combined with spinal manipulative or NSAID therapy for chronic low back pain: a randomized, observer-blinded clinical trial.
abstract: OBJECTIVE
  To study the relative efficacy of three different treatment for chronic low back pain (CLBP). Two preplanned comparisons were made: (a) Spinal manipulative therapy (SMT) combined with trunk strengthening exercises (TSE) vs. SMT combined with trunk stretching exercises, and (b) SMT combined with TSE vs. nonsteroidal anti-inflammatory drug (NSAID) therapy combined with TSE.
  
  
  METHODS
  Interdisciplinary, prospective, observer-blinded, randomized clinical trial with a 1-yr follow-up period. The trial evaluated therapies in combination only and was not designed to test the individual treatment components.
  
  
  METHODS
  Primary contact, college out-patient clinic.
  
  
  METHODS
  In total, 174 patients aged 20-60 yr were admitted to the study.
  
  
  METHODS
  Patient-rated low back pain, disability, and functional health status at 5 and 11 wk.
  
  
  METHODS
  Five weeks of SMT or NSAID therapy in combination with supervised trunk exercise, followed by and additional 6 wk of supervised exercise alone.
  
  
  RESULTS
  Individual group comparisons after 5 and 11 wk of intervention on all three main outcome measures did not reveal any clear clinically important or statistically significant differences. There seemed to be a sustained reduction in medication use at the 1-yr follow-up. in the SMT/TSE group. Continuance of exercise during the follow-up year, regardless of type, was associated with a better outcome.
  
  
  CONCLUSIONS
  Each of the three therapeutic regimens was associated with similar and clinically important improvement over time that was considered superior to the expected natural history of long-standing CLBP. For the management of CLBP, trunk exercise in combination with SMT or NSAID therapy seemed to be beneficial and worthwhile. The magnitude of nonspecific therapeutic (placebo) effects, cost-effectiveness and relative risks of side effects associated with these types of therapy need to be addressed in future studies.
authors.affiliation: Northwestern College of Chiropractic, Department of Research, Bloomington, Minnesota, USA.
authors.forename: G
authors.initials: G
authors.lastname: Bronfort
authors.forename: C H
authors.initials: CH
authors.lastname: Goldsmith
authors.forename: C F
authors.initials: CF
authors.lastname: Nelson
authors.forename: P D
authors.initials: PD
authors.lastname: Boline
authors.forename: A V
authors.initials: AV
authors.lastname: Anderson
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002908:Chronic Disease; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy / Q000628:therapy*; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D009288:Naproxen / Q000627:therapeutic use*; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D009288:Naproxen