title: Short-term effectiveness of spinal manipulative therapy versus functional technique in patients with chronic nonspecific low back pain: a pragmatic randomized controlled trial.
abstract: BACKGROUND
  Chronic low back pain (LBP) is a prevalent condition associated with pain, disability, decreased quality of life, and fear of movement. To date, no studies have compared the effectiveness of spinal manipulation and functional technique for the management of this population.
  
  
  OBJECTIVE
  This study aimed to compare the effectiveness of spinal manipulation and functional technique on pain, disability, kinesiophobia, and quality of life in patients with chronic LBP.
  
  
  METHODS
  A single-blind pragmatic randomized controlled trial conducted in a university research clinic was carried out.
  
  
  METHODS
  Sixty-two patients (62% female, age: 45±7) with chronic LBP comprised the patient sample.
  
  
  METHODS
  Data on disability (Roland-Morris Disability Questionnaire [RMQ], Oswestry Low Back Pain Disability Index [ODI]), pain intensity (Numerical Pain Rate Scale [NPRS]), fear of movement (Tampa Scale of Kinesiophobia [TSK]), quality of life (Short Form-36 [SF-36] quality of life questionnaire), isometric resistance of abdominal muscles (McQuade test), and spinal mobility in flexion (finger-to-floor distance) were collected at baseline immediately after the intervention phase and at 1 month postintervention by an assessor blinded to group allocation of the patients.
  
  
  METHODS
  Patients were randomly assigned to the spinal manipulative therapy group or the functional technique group and received three once-weekly sessions.
  
  
  RESULTS
  In comparison to patients receiving functional technique, those receiving spinal manipulation experienced statistically, although not clinically, significant greater reductions in terms of RMQ (standardized mean difference in score changes between groups at post-treatment: 0.1; at 1 month: 0.1) and ODI (post-treatment: 2.9; at 1 month: 1.4). Linear longitudinal analysis showed a significant improvement in both groups over time for RMQ (manipulative: F=68.51, p<.001; functional: F=28.58, p<.001) and ODI (manipulative: F=104.66, p<.001; functional: F=32.15, p=.001). However, significant treatment-by-time interactions were not detected for pain intensity (p=.488), TSK (p=.552), any domains of the SF-36 quality of life questionnaire (p≤.164), McQuade test (p=.512), and finger-to-floor distance (p=.194). Differences between and within groups were not clinically meaningful in any of the reported measures.
  
  
  CONCLUSIONS
  In comparison to functional technique, spinal manipulative therapy showed greater reduction in disability in patients with chronic LBP, but not in terms of pain, fear of movement, quality of life, isometric resistance of trunk flexors, or spinal mobility. However, differences in disability were not clinically meaningful; therefore, spinal manipulative therapy did not result in any clinically important short-term benefits over functional technique therapy. In addition, as neither group met the threshold for minimum clinically important difference following treatment, neither treatment resulted in a clinically meaningful benefit.
authors.affiliation: Department of Nursing, Physical Therapy and Medicine, University of Almeria, Carretera de Sacramento s/n, 04120, Spain. Electronic address: adelaid@ual.es.
authors.forename: Adelaida María
authors.initials: AM
authors.lastname: Castro-Sánchez
authors.affiliation: Department of Nursing, Physical Therapy and Medicine, University of Almeria, Carretera de Sacramento s/n, 04120, Spain.
authors.forename: Inmaculada C
authors.initials: IC
authors.lastname: Lara-Palomo
authors.affiliation: Andalusian Health Service, Primary Health Medical, Av. de la Constitución, 18, 41071, Spain.
authors.forename: Guillermo A
authors.initials: GA
authors.lastname: Matarán-Peñarrocha
authors.affiliation: Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Av. Atenas, S/N, 28922, Alcorcón, Madrid, Spain; Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Esthesiology Laboratory of Universidad Rey Juan Carlos, Av. Atenas, S/N, 28922, Alcorcón, Spain.
authors.forename: César
authors.initials: C
authors.lastname: Fernández-de-Las-Peñas
authors.affiliation: Department of Nursing, Physical Therapy and Medicine, University of Almeria, Carretera de Sacramento s/n, 04120, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Saavedra-Hernández
authors.affiliation: Department of Physical Therapy, Franklin Pierce University, 40 University Drive Rindge, Concord, NH, 03461-0060, USA; Rehabilitation Services, Concord Hospital, 250 Pleasant St, Concord, NH, 03301, USA; Manual Therapy Fellowship Program, Regis University, 3333 Regis Blvd, Denver, CO, 80221, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Cleland
authors.affiliation: Department of Physical Therapy, University of Granada, Avenida de Madrid s/n, 18071, Spain.
authors.forename: María Encarnación
authors.initials: ME
authors.lastname: Aguilar-Ferrándiz
mesh_terms: D000328:Adult; D015444:Exercise / Q000523:psychology; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology / Q000628:therapy*; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D009068:Movement; D010147:Pain Measurement; D010698:Phobic Disorders / Q000523:psychology; D026741:Physical Therapy Modalities; D011788:Quality of Life; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Chronic pain; Disability evaluation; Low back pain; Manipulation; Quality of life; Randomized controlled trial