Three combinations of manual therapy techniques within naprapathy in the treatment of neck and/or back pain: a randomized controlled trial.
BACKGROUND
Manual therapy as spinal manipulation, spinal mobilization, stretching and massage are common treatment methods for neck and back pain. The objective was to compare the treatment effect on pain intensity, pain related disability and perceived recovery from a) naprapathic manual therapy (spinal manipulation, spinal mobilization, stretching and massage) to b) naprapathic manual therapy without spinal manipulation and to c) naprapathic manual therapy without stretching for male and female patients seeking care for back and/or neck pain.


METHODS
Participants were recruited among patients, ages 18-65, seeking care at the educational clinic of Naprapathögskolan - the Scandinavian College of Naprapathic Manual Medicine in Stockholm. The patients (n = 1057) were randomized to one of three treatment arms a) manual therapy (i.e. spinal manipulation, spinal mobilization, stretching and massage), b) manual therapy excluding spinal manipulation and c) manual therapy excluding stretching. The primary outcomes were minimal clinically important improvement in pain intensity and pain related disability. Treatments were provided by naprapath students in the seventh semester of eight total semesters. Generalized estimating equations and logistic regression were used to examine the association between the treatments and the outcomes.


RESULTS
At 12 weeks follow-up, 64% had a minimal clinically important improvement in pain intensity and 42% in pain related disability. The corresponding chances to be improved at the 52 weeks follow-up were 58% and 40% respectively. No systematic differences in effect when excluding spinal manipulation and stretching respectively from the treatment were found over 1 year follow-up, concerning minimal clinically important improvement in pain intensity (p = 0.41) and pain related disability (p = 0.85) and perceived recovery (p = 0.98). Neither were there disparities in effect when male and female patients were analyzed separately.


CONCLUSIONS
The effect of manual therapy for male and female patients seeking care for neck and/or back pain at an educational clinic is similar regardless if spinal manipulation or if stretching is excluded from the treatment option.


BACKGROUND
Current Controlled Trials ISRCTN92249294.
Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden.|Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Kräftriket 23A, Stockholm, SE-11419, Sweden.
Kari
K
Paanalahti
Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden.|Institute of Health Policy, Management and Evaluation, University of Toronto, 4th Floor, 155 College St, Toronto, ON M5T 3 M6, Canada.
Lena W
LW
Holm
Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden.|Occupational and Industrial Orthopaedic Center (OIOC), NYU Hospital for Joint Diseases, New York University Langone Medical Center, 63 Downing Street, New York, NY, 10014, USA.
Margareta
M
Nordin
Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden.
Jonas
J
Höijer
Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Kräftriket 23A, Stockholm, SE-11419, Sweden.
Jessica
J
Lyander
Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden.|Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Kräftriket 23A, Stockholm, SE-11419, Sweden.
Martin
M
Asker
Musculoskeletal & Sports Injury Epidemiology Center, Institute of Environmental Medicine, Karolinska Institutet, Box 210, Stockholm, SE-17177, Sweden. eva.skillgate@ki.se.|Naprapathögskolan - Scandinavian College of Naprapathic Manual Medicine, Kräftriket 23A, Stockholm, SE-11419, Sweden. eva.skillgate@ki.se.
Eva
E
Skillgate
D000328:Adult; D001416:Back Pain / Q000453:epidemiology / Q000628:therapy*; D003131:Combined Modality Therapy / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D008405:Massage / Q000379:methods*; D008875:Middle Aged; D052580:Muscle Stretching Exercises / Q000379:methods*; D019547:Neck Pain / Q000453:epidemiology / Q000628:therapy*; D010147:Pain Measurement / Q000379:methods; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
Back pain; Muskuloskeletal manipulations; Naprapathy; Neck pain