The long-term effects of naprapathic manual therapy on back and neck pain - results from a pragmatic randomized controlled trial.
BACKGROUND
Back and neck pain are very common, disabling and recurrent disorders in the general population and the knowledge of long-term effect of treatments are sparse. The aim of this study was to compare the long-term effects (up to one year) of naprapathic manual therapy and evidence-based advice on staying active regarding non-specific back and/or neck pain. Naprapathy, a health profession mainly practiced in Sweden, Finland, Norway and in the USA, is characterized by a combination of manual musculoskeletal manipulations, aiming to decrease pain and disability in the neuromusculoskeletal system.


METHODS
Subjects with non-specific pain/disability in the back and/or neck lasting for at least two weeks (n = 409), recruited at public companies in Sweden, were included in this pragmatic randomized controlled trial. The two interventions compared were naprapathic manual therapy such as spinal manipulation/mobilization, massage and stretching, (Index Group), and advice to stay active and on how to cope with pain, provided by a physician (Control Group). Pain intensity, disability and health status were measured by questionnaires.


RESULTS
89% completed the 26-week follow-up and 85% the 52-week follow-up. A higher proportion in the Index Group had a clinically important decrease in pain (risk difference (RD) = 21%, 95% CI: 10-30) and disability (RD = 11%, 95% CI: 4-22) at 26-week, as well as at 52-week follow-ups (pain: RD = 17%, 95% CI: 7-27 and disability: RD = 17%, 95% CI: 5-28). The differences between the groups in pain and disability considered over one year were statistically significant favoring naprapathy (p < or = 0.005). There were also significant differences in improvement in bodily pain and social function (subscales of SF-36 health status) favoring the Index Group.


CONCLUSIONS
Combined manual therapy, like naprapathy, is effective in the short and in the long term, and might be considered for patients with non-specific back and/or neck pain.


BACKGROUND
Current Controlled Trials ISRCTN56954776.
Skillgate
Eva
E
Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-17177, Stockholm, Sweden. eva.skillgate@ki.se
Bohman
Tony
T
Holm
Lena W
LW
Vingård
Eva
E
Alfredsson
Lars
L
D000328:Adult; D001416:Back Pain / Q000628:therapy*; D000529:Complementary Therapies / Q000379:methods*; D004185:Disability Evaluation; D055317:Evidence-Based Practice; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D019547:Neck Pain / Q000628:therapy*; D011788:Quality of Life; D012919:Social Behavior; D016896:Treatment Outcome