title: Naprapathic manual therapy or evidence-based care for back and neck pain: a randomized, controlled trial.
abstract: OBJECTIVE
  To compare naprapathic manual therapy with evidence-based care for back or neck pain regarding pain, disability, and perceived recovery. Naprapathy that is common in the Nordic countries and in some states in the United States is characterized by manual manipulations with a focus on soft and connective tissues, aiming to decrease pain and disability in the musculoskeletal system.
  
  
  METHODS
  Four hundred and nine patients with pain and disability in the back or neck lasting for at least 2 weeks, recruited at 2 large public companies in Sweden in 2005, were included in this randomized controlled trial. The 2 interventions were naprapathy, including spinal manipulation/mobilization, massage, and stretching (Index Group) and support and advice to stay active and how to cope with pain, according to the best scientific evidence available, provided by a physician (Control Group). Pain, disability, and perceived recovery were measured by questionnaires at baseline and after 3, 7, and 12 weeks.
  
  
  RESULTS
  At 7-week and 12-week follow-ups, statistically significant differences between the groups were found in all outcomes favoring the Index Group. At 12-week follow-up, a higher proportion in the naprapathy group had improved regarding pain [risk difference (RD)=27%, 95% confidence interval (CI): 17-37], disability (RD=18%, 95% CI: 7-28), and perceived recovery (RD=44%, 95% CI: 35-53). Separate analysis of neck pain and back pain patients showed similar results.
  
  
  CONCLUSIONS
  This trial suggests that combined manual therapy, like naprapathy, might be an alternative to consider for back and neck pain patients.
authors.affiliation: Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden. eva.skillgate@ki.se
authors.forename: Eva
authors.initials: E
authors.lastname: Skillgate
authors.forename: Eva
authors.initials: E
authors.lastname: Vingård
authors.forename: Lars
authors.initials: L
authors.lastname: Alfredsson
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001416:Back Pain / Q000628:therapy*; D000529:Complementary Therapies / Q000009:adverse effects; D004185:Disability Evaluation; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000009:adverse effects; D019547:Neck Pain / Q000628:therapy*; D010147:Pain Measurement; D018401:Sample Size; D016896:Treatment Outcome