title: Naprapathic manual therapy or conventional orthopedic care for outpatients on orthopedic waiting lists?: A pragmatic randomized controlled trial.
abstract: OBJECTIVE
  Traditionally, orthopedic outpatient waiting lists are long, and many referrals are for conditions that do not respond to interventions available at an orthopedic outpatient department. The overall objective of this trial was to investigate whether it is possible to reduce orthopedic waiting lists through integrative medicine. Specific aims were to compare the effects of naprapathic manual therapy to conventional orthopedic care for outpatients with nonurgent musculoskeletal disorders unlikely to benefit from surgery regarding pain, physical function, and perceived recovery.
  
  
  METHODS
  Seventy-eight patients referred to an orthopedic outpatient department in Sweden were included in this pragmatic randomized controlled trial. The 2 interventions compared were naprapathic manual therapy (index group) and conventional orthopedic care (control group). Pain, physical function, and perceived recovery were measured by questionnaires at baseline and after 12, 24, and 52 weeks. The number of patients being discharged from the waiting lists and the level of agreement concerning management decisions between the naprapath and the orthopedists were also estimated.
  
  
  RESULTS
  After 52 weeks, statistically significant differences between the groups were found regarding impairment in pain, increased physical function, and regarding perceived recovery, favoring the index group. Sixty-two percent of the patients in the index group agreed to be discharged from the waiting list. The level of agreement concerning the management decisions was 80%.
  
  
  CONCLUSIONS
  The trial suggests that naprapathic manual therapy may be an alternative to consider for orthopedic outpatients with disorders unlikely to benefit from surgery.
authors.affiliation: Orthopedic Department, Blekingesjukhuset, Karlskrona, Sweden. titti.lilje@euromail.se
authors.forename: Stina
authors.initials: S
authors.lastname: Lilje
authors.forename: Håkan
authors.initials: H
authors.lastname: Friberg
authors.forename: Anders
authors.initials: A
authors.lastname: Wykman
authors.forename: Eva
authors.initials: E
authors.lastname: Skillgate
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D055048:Integrative Medicine; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D009985:Orthopedics; D010045:Outpatients; D059408:Pain Management; D018579:Patient Selection; D020127:Recovery of Function; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013548:Sweden; D016896:Treatment Outcome; D014850:Waiting Lists