title: Long-term effectiveness of bone-setting, light exercise therapy, and physiotherapy for prolonged back pain: a randomized controlled trial.
abstract: BACKGROUND
  Chiropractic manipulation and strenuous exercise therapy have been shown effective in the treatment of nonspecific back pain. Bone-setting, the predecessor of modern manual therapies, still survives in some parts of Finland and was compared with a light exercise therapy and non-manipulative, pragmatic physiotherapy in a year-long randomized controlled trial on patients with long-term back pain.
  
  
  METHODS
  One hundred fourteen ambulatory patients of working age with back pain for 7 weeks or more were randomly assigned to the therapies, which were offered in up to 10 sessions during a 6-week treatment period. The outcome was measured by the Oswestry Disability Questionnaire. Sick-leaves and visits to health centers were recorded for 1 year before and after the therapy.
  
  
  RESULTS
  The Oswestry disability scores improved most in the bone-setting group (P =.02, Kruskall-Wallis test). Visits to health centers for back pain were reduced only in the physiotherapy group (P =.01, Wilcoxon test). Sick-leaves were not significantly different between groups. A secondary analysis based on the use of additional therapies after the intervention showed a possible subgroup with an enhanced effect from bone-setting.
  
  
  CONCLUSIONS
  Traditional bone-setting seemed more effective than exercise or physiotherapy on back pain and disability, even 1 year after therapy.
authors.affiliation: Folk Medicine Centre, Kaustinen, Finland. heikki.hemmila@pp.finet.fi
authors.forename: Heikki M
authors.initials: HM
authors.lastname: Hemmilä
authors.forename: Sirkka M
authors.initials: SM
authors.lastname: Keinänen-Kiukaanniemi
authors.forename: Sinikka
authors.initials: S
authors.lastname: Levoska
authors.forename: Pekka
authors.initials: P
authors.lastname: Puska
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy*; D026882:Manipulation, Chiropractic / Q000379:methods*; D008519:Medicine, Traditional; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000379:methods*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome