title: Manual Therapy by General Medical Practitioners for Nonspecific Low Back Pain in Primary Care: The ManRück Study Protocol of a Clinical Trial.
abstract: BACKGROUND
  Nonspecific low back pain (LBP) is a common reason for accessing primary care. Manual therapy (MT) may be an effective treatment, but data from clinical studies including relevant subgroups and clinical settings are sparse. The objective of this article is to describe the protocol of a study that will measure whether an MT protocol provided by general medical practitioners will lead to a faster pain reduction in patients with nonspecific LBP than does standard medical care.
  
  
  METHODS
  The study is an experimental pre-/postintervention design. The intervention consists of add-on MT treatment by general medical practitioners who have received MT training but are otherwise inexperienced in mobilization techniques. Participating general medical practitioners (n = 10) will consecutively recruit and treat patients before and after their training, serving as their own internal controls. The primary end point is a combined outcome assessing change in pain score over days 0 to 3 and time until pain is reduced by 2 points on an 11-point numeric pain scale and painkiller use is stopped. Secondary outcomes are patients' functional capacities assessed using a questionnaire, amount of sick leave taken, patient satisfaction, and referrals for further treatment.
  
  
  BACKGROUND
  German clinical trials register: DRKS-ID DRKS00003240.
authors.affiliation: Group Leader, Department for Health Services Research, Institute for Public Health and Nursing Science, Bremen University, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Schmiemann
authors.affiliation: Medical Student, Centre for Public Healthcare, Hannover Medical School, Hannover, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Blase
authors.affiliation: General Practitioner, Practice Dr. Seeber, Leer, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Seeber
authors.affiliation: Professor, Deputy Head of Department, Department of General Practice and Health Services Research University Hospital Heidelberg, Heidelberg, Germany ; Head, Department of General Practice, Tübingen, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Joos
authors.affiliation: Professor, Researcher, Department of General Practice and Health Services Research University Hospital Heidelberg, Heidelberg, Germany ; Professor, Head of Department of General Practice, Lübeck, Germany.
authors.forename: Jost
authors.initials: J
authors.lastname: Steinhäuser
authors.affiliation: Biometrician, Institute of Biostatistics, Hanover Medical School, Hannover, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Ernst
authors.affiliation: Group leader, Institute of Biostatistics, Hanover Medical School, Hannover, Germany.
authors.forename: Anika
authors.initials: A
authors.lastname: Großhennig
authors.affiliation: Professor, Director, Department of General Practice and Family Medicine, University of Goettingen, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Hummers-Pradier
authors.affiliation: Group Leader, Centre for Public Healthcare, Hannover Medical School, Hannover, Germany.
authors.forename: Heidrun
authors.initials: H
authors.lastname: Lingner
keywords: General practice; Low back pain; Manual therapy