Orthopaedic manual therapy, McKenzie method or advice only for low back pain in working adults: a randomized controlled trial with one year follow-up.

OBJECTIVE: To examine the effects of 2 manual therapy methods compared with one counselling session with a physiotherapist with "advice-only to stay active" for treating low back pain/leg pain and disability. DESIGN: A randomized, controlled trial with a 1-year follow-up. SUBJECTS: A total of 134 subjects with low back disorders. METHODS: Participants with acute to chronic first or recurrent low back pain, excluding those with "red flag" criteria, were assigned randomly to one of the 3 intervention groups: an orthopaedic manual therapy group (n=45), a McKenzie method group (n=52), and an "advice only to be active" group (advice-only) (n=37). Data on leg and low back pain intensity and disability (Roland-Morris Disability questionnaire) were collected at baseline, and at 3-, 6-, and 12-month follow-up points. RESULTS: At the 3-month follow-up point, significant improvements had occurred in all groups in leg and low back pain and in the disability index, but with no significant differences between the groups. At the 6-month follow-up, leg pain (-15 mm; 95% confidence interval (CI) -30 to -1), back pain (effect: -15 mm; -27 to -4), and disability index (-4 points; -7 to -1) improved (p < 0.05) more in the McKenzie method group than in the advice-only group. At the 1-year follow-up, the McKenzie method group had (p=0.028) a better disability index (-3 points; -6 to 0) than did the advice-only group. In the orthopaedic manual therapy group at the 6-month and 1-year follow-up visits, improvements in the pain and disability index were somewhat better than in the advice-only group (p=0.067 and 0.068, respectively). No differences emerged between the orthopaedic manual therapy and McKenzie method groups in pain- and disability-score changes at any follow-up. CONCLUSION: The orthopaedic manual therapy and McKenzie methods seemed to be only marginally more effective than was one session of assessment and advice-only.