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2014 ; 14
(7
): 1106-16
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Dose-response and efficacy of spinal manipulation for care of chronic low back
pain: a randomized controlled trial
#MMPMID24139233
Haas M
; Vavrek D
; Peterson D
; Polissar N
; Neradilek MB
Spine J
2014[Jul]; 14
(7
): 1106-16
PMID24139233
show ga
BACKGROUND CONTEXT: There have been no full-scale trials of the optimal number of
visits for the care of any condition with spinal manipulation. PURPOSE: To
identify the dose-response relationship between visits to a chiropractor for
spinal manipulation and chronic low back pain (cLBP) outcomes and to determine
the efficacy of manipulation by comparison with a light massage control. STUDY
DESIGN/SETTING: Practice-based randomized controlled trial. PATIENT SAMPLE: Four
hundred participants with cLBP. OUTCOME MEASURES: The primary cLBP outcomes were
the 100-point modified Von Korff pain intensity and functional disability scales
evaluated at the 12- and 24-week primary end points. Secondary outcomes included
days with pain and functional disability, pain unpleasantness, global perceived
improvement, medication use, and general health status. METHODS: One hundred
participants with cLBP were randomized to each of four dose levels of care: 0, 6,
12, or 18 sessions of spinal manipulation from a chiropractor. Participants were
treated three times per week for 6 weeks. At sessions when manipulation was not
assigned, they received a focused light massage control. Covariate-adjusted
linear dose effects and comparisons with the no-manipulation control group were
evaluated at 6, 12, 18, 24, 39, and 52 weeks. RESULTS: For the primary outcomes,
mean pain and disability improvement in the manipulation groups were 20 points by
12 weeks and sustainable to 52 weeks. Linear dose-response effects were small,
reaching about two points per six manipulation sessions at 12 and 52 weeks for
both variables (p<.025). At 12 weeks, the greatest differences from the
no-manipulation control were found for 12 sessions (8.6 pain and 7.6 disability
points, p<.025); at 24 weeks, differences were negligible; and at 52 weeks, the
greatest group differences were seen for 18 visits (5.9 pain and 8.8 disability
points, p<.025). CONCLUSIONS: The number of spinal manipulation visits had modest
effects on cLBP outcomes above those of 18 hands-on visits to a chiropractor.
Overall, 12 visits yielded the most favorable results but was not well
distinguished from other dose levels.