title: Spinal Manipulative Therapy for Chronic Lower Back Pain in Older Veterans: A Prospective, Randomized, Placebo-Controlled Trial.
abstract: BACKGROUND
  Chronic lower back pain (CLBP) is problematic in older veterans. Spinal manipulative therapy (SMT) is commonly utilized for CLBP in older adults, yet there are few randomized placebo-controlled trials evaluating SMT.
  
  
  METHODS
  The purpose of the study was to compare the effectiveness of SMT to a sham intervention on pain (Visual Analogue Scale, SF-36 pain subscale), disability (Oswestry Disability Index), and physical function (SF-36 subscale, Timed Up and Go) by performing a randomized placebo-controlled trial at 2 Veteran Affairs Clinics.
  
  
  RESULTS
  Older veterans (≥ 65 years of age) who were naive to chiropractic were recruited. A total of 136 were included in the study with 69 being randomly assigned to SMT and 67 to sham intervention. Patients were treated 2 times per week for 4 weeks assessing outcomes at baseline, 5, and 12 weeks postbaseline. Both groups demonstrated significant decrease in pain and disability at 5 and 12 weeks. At 12 weeks, there was no significant difference in pain and a statistically significant decline in disability scores in the SMT group when compared to the sham intervention group. There were no significant differences in adverse events between the groups.
  
  
  CONCLUSIONS
  The SMT did not result in greater improvement in pain when compared to our sham intervention; however, SMT did demonstrate a slightly greater improvement in disability at 12 weeks. The fact that patients in both groups showed improvements suggests the presence of a nonspecific therapeutic effect.
authors.affiliation: Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA ; New York Chiropractic College, Seneca Falls, NY, USA ; University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Dougherty
authors.affiliation: New York Chiropractic College, Seneca Falls, NY, USA ; University of Rochester School of Medicine and Dentistry, Rochester, NY, USA ; State University of New York College at Buffalo, Buffalo, NY, USA.
authors.forename: Jurgis
authors.initials: J
authors.lastname: Karuza
authors.affiliation: New York Chiropractic College, Seneca Falls, NY, USA ; VA Western New York Healthcare System, Buffalo, NY, USA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Dunn
authors.affiliation: Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, USA.
authors.forename: Dorian
authors.initials: D
authors.lastname: Savino
authors.affiliation: University of Toronto, Toronto, Canada ; Baycrest Geriatric Centre, Toronto, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Katz
keywords: chronic lower back pain; older adults; randomized placebo controlled trial; spinal manipulative therapy; veterans