title: Similar Effects of Thrust and Nonthrust Spinal Manipulation Found in Adults With Subacute and Chronic Low Back Pain: A Controlled Trial With Adaptive Allocation.
abstract: METHODS
  A three-arm controlled trial with adaptive allocation.
  
  
  OBJECTIVE
  The aim of this study was to compare short-term effects of a side-lying, thrust spinal manipulation (SM) procedure and a nonthrust, flexion-distraction SM procedure in adults with subacute or chronic low back pain (LBP) over 2 weeks.
  
  
  BACKGROUND
  SM has been recommended in recently published clinical guidelines for LBP management. Previous studies suggest that thrust and nonthrust SM procedures, though distinctly different in joint loading characteristics, have similar effects on patients with LBP.
  
  
  METHODS
  Participants were eligible if they were 21 to 54 years old, had LBP for at least 4 weeks, scored 6 or above on the Roland-Morris disability questionnaire, and met the diagnostic classification of 1, 2, or 3 according to the Quebec Task Force Classification for Spinal Disorders. Participants were allocated in a 3:3:2 ratio to four sessions of thrust or nonthrust SM procedures directed at the lower lumbar and pelvic regions, or to a 2-week wait list control. The primary outcome was LBP-related disability using Roland-Morris Disability Questionnaire and the secondary outcomes were LBP intensity using visual analog scale, Fear-Avoidance Beliefs Questionnaire, and the 36-Item Short Form Health Survey. The study was conducted at the Palmer Center for Chiropractic Research with care provided by experienced doctors of chiropractic. Clinicians and patients were not blinded to treatment group.
  
  
  RESULTS
  Of 192 participants enrolled, the mean age was 40 years and 54% were male. Improvement in disability, LBP intensity, Fear-Avoidance Beliefs Questionnaire-work subscale, and 36-Item Short Form Health Survey-physical health summary measure for the two SM groups were significantly greater than the control group. No difference in any outcomes was observed between the two SM groups.
  
  
  CONCLUSIONS
  Thrust and nonthrust SM procedures with distinctly different joint loading characteristics demonstrated similar effects in short-term LBP improvement and both were superior to a wait list control.
  
  
  METHODS
  2.
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA.
authors.forename: Ting
authors.initials: T
authors.lastname: Xia
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA.
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Long
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA.
authors.forename: Maruti R
authors.initials: MR
authors.lastname: Gudavalli
authors.affiliation: Department of Biomedical Engineering, University of Iowa, Iowa City, IA.
authors.forename: David G
authors.initials: DG
authors.lastname: Wilder
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Vining
authors.affiliation: Diagnosis & Radiology, Palmer College of Chiropractic, Davenport, IA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rowell
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA.
authors.forename: William R
authors.initials: WR
authors.lastname: Reed
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA.
authors.forename: James W
authors.initials: JW
authors.lastname: DeVocht
authors.affiliation: Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Goertz
authors.affiliation: Dr. Sid E. Williams Center for Chiropractic Research, Life University, Marietta, GA.
authors.forename: Edward F
authors.initials: EF
authors.lastname: Owens
authors.affiliation: Palmer College of Chiropractic-West Campus, San Jose, CA.
authors.forename: William C
authors.initials: WC
authors.lastname: Meeker
mesh_terms: D059787:Acute Pain / Q000175:diagnosis / Q000628:therapy*; D000328:Adult; D059350:Chronic Pain / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D016037:Single-Blind Method; D016896:Treatment Outcome; D055815:Young Adult