title: A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain.
abstract: METHODS
  A prospective randomized controlled trial.
  
  
  OBJECTIVE
  To examine the effectiveness of combined manipulative treatment, stabilizing exercises, and physician consultation compared with physician consultation alone for chronic low back pain.
  
  
  BACKGROUND
  Strong evidence exists that manual therapy provides more effective short-term pain relief than does placebo treatment in the management of chronic low back pain. The evidence for long-term effect is lacking.
  
  
  METHODS
  Two hundred four chronic low back pain patients, whose Oswestry disability index was at least 16%, were randomly assigned to either a manipulative-treatment group or a consultation group. All were clinically examined, informed about their back pain, provided with an educational booklet, and were given specific instructions based on the clinical evaluation. The treatment included four sessions of manipulation and stabilizing exercises aiming to correct the lumbopelvic rhythm. Questionnaires inquired about pain intensity, self-rated disability, mental depression, health-related quality of life, health care costs, and production costs.
  
  
  RESULTS
  At the baseline, the groups were comparable, except for the percentage of employees (P = 0.01). At the 5- and 12-month follow-ups, the manipulative-treatment group showed more significant reductions in pain intensity (P < 0.001) and in self-rated disability (P = 0.002) than the consultation group. However, we detected no significant difference between the groups in health-related quality of life or in costs.
  
  
  CONCLUSIONS
  The manipulative treatment with stabilizing exercises was more effective in reducing pain intensity and disability than the physician consultation alone. The present study showed that short, specific treatment programs with proper patient information may alter the course of chronic low back pain.
authors.affiliation: Rehabilitation Unit of the Orthopaedic Hospital Orton, Invalid Foundation, Helsinki, Finland. leena.niemisto@fimnet.fi
authors.forename: Leena
authors.initials: L
authors.lastname: Niemistö
authors.forename: Tiina
authors.initials: T
authors.lastname: Lahtinen-Suopanki
authors.forename: Pekka
authors.initials: P
authors.lastname: Rissanen
authors.forename: Karl-August
authors.initials: KA
authors.lastname: Lindgren
authors.forename: Seppo
authors.initials: S
authors.lastname: Sarna
authors.forename: Heikki
authors.initials: H
authors.lastname: Hurri
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000191:economics / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D016896:Treatment Outcome