Manual therapy and active exercises improve disability in patients with CNLBP .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(6):91 BMC Musculoskelet Disord. 2012 Aug 28;13:162. doi: 10.1186/1471-2474-13-162.42 chronic non-specific low back pain patients without co-morbidities were randomized to receive spinal manipulation plus active exercises or detuned ultrasound plus active exercises. The results of the study indicate that manual therapy alone produced a slightly greater immediate analgesic effect, but the combination of manual therapy and active exercises resulted in reduced disability and a trend towards lower back pain.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
4/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
For approximately 10% of nonspecific low back pain sufferers, pain and disability may be experienced for a longer period of time. Unfortunately, treatment of chronic non-specific low back pain can be complicated, expensive, and inconsistently effective. This study aimed to determine whether manual therapy produces an analgesic effect and whether manual therapy followed by active exercises improves functional disability when compared to sham therapy followed by active exercises.
¿Cuál era la pregunta principal de la investigación?
Does manual therapy followed by active exercises improve the functional disability of patients with chronic non-specific low back pain when compared to sham therapy followed by active exercises, 6 months after treatment?
- Immediately after manual therapy or sham therapy, the patients who received manual therapy experienced a significant reduction in mean pain level when compared to the patients that received sham therapy (Mean difference: -0.76 VAS; 95% CI: -1.22 to -0.30).
- The patients that completed manual therapy followed by active exercises displayed a trend towards a significant reduction in pain when compared to the patients that completed sham therapy followed by active exercises (Mean difference: -1.24; 95% CI: -2.73 to -0.30; p=0.032).
- Disability was found to be significantly less among the patients that underwent manual therapy and active exercise when compared to the patients that underwent sham therapy and active exercise (Mean difference: -7.14; 95% CI:-12.8 to -1.52; p=0.013).
- At the immediate and 3 month follow-ups, there was no significant difference in mean Shirado score (erector spine and abdominal muscles endurance) between the two treatment groups (p=0.352 and p=0.246, respectively), but at the 6 month follow-up, the Shirado score was significantly lower among the patients that underwent manual therapy than the patients that underwent the sham therapy (p=0.031).
- There were no significant differences in Sorensen scores or Fear-Avoidance Beliefs Questionnaire scores between the treatment groups.
¿Qué es lo que más debo recordar?
The data suggests that manual therapy provides immediate analgesic effects. The combination of manual therapy and active exercises improved disability and displayed a trend towards significantly reducing pain. The combination of sham therapy and active exercises significantly improved mean Shirado scores.
¿Cómo afectará esto al cuidado de mis pacientes?
The study suggests that manual therapy may provide immediate analgesic effects and the combination of manual therapy and active exercises may significantly improve disability and display a trend towards significantly improving pain. Further research using larger sample sizes are required to detect significant differences in study outcomes.
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