Randomised clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow up.

OBJECTIVE: To compare the effectiveness of manipulative therapy, physiotherapy, treatment by the general practitioner, and placebo therapy in patients with persistent non-specific back and neck complaints. DESIGN: Randomised clinical trial. SETTING: Primary health care in the Netherlands. PATIENTS: 256 patients with non-specific back and neck complaints of at least six weeks' duration who had not received physiotherapy or manipulative therapy in the past two years. INTERVENTIONS: At the discretion of the manipulative therapists, physiotherapists, and general practitioners. Physiotherapy consisted of exercises, massage, and physical therapy (heat, electrotherapy, ultrasound, shortwave diathermy). Manipulative therapy consisted of manipulation and mobilisation of the spine. Treatment by general practitioners consisted of drugs (for example, analgesics), advice about posture, home exercises, and (bed)rest. Placebo treatment consisted of detuned shortwave diathermy (10 minutes) and detuned ultrasound (10 minutes). MAIN OUTCOME MEASURES: Changes in severity of the main complaint and limitation of physical functioning measured on 10 point scales by a blinded research assistant and global perceived effect measured on a 6 point scale by the patients. RESULTS: Many patients in the general practitioner and placebo groups received other treatment during follow up. Improvement in the main complaint was larger with manipulative therapy (4.5) than with physiotherapy (3.8) after 12 months' follow up (difference 0.9; 95% confidence interval 0.1 to 1.7). Manipulative therapy also gave larger improvements in physical functioning (difference 0.6; -0.1 to 1.3). The global perceived effect after six and 12 months' follow up was similar for both treatments. CONCLUSIONS: Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months.

A blinded randomized clinical trial of manual therapy and physiotherapy for chronic back and neck complaints: physical outcome measures.

In a blinded randomized clinical trial, we compared the effectiveness of manual therapy, physiotherapy, (continued) treatment by the general practitioner (GP), and a placebo therapy (detuned ultrasound and detuned short wave diathermy) for patients (n = 256) with chronic nonspecific back and neck complaints. The physical outcome measures (spinal mobility and physical functioning) are presented for 3, 6 and 12 wk follow-up. Manual therapy showed a faster and larger improvement in physical functioning compared to the other three therapies. The changes in spinal mobility among the four study groups appear to be small and show no consistent pattern.

The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. A randomized clinical trial.

In a randomized trial, the effectiveness of manual therapy, physiotherapy, continued treatment by the general practitioner, and placebo therapy (detuned ultrasound and detuned short-wave diathermy) were compared for patients (n = 256) with nonspecific back and neck complaints lasting for at least 6 weeks. The principle outcome measures were severity of the main complaint, global perceived effect, pain, and functional status. These are presented for 3, 6, and 12 weeks follow-up. Both physiotherapy and manual therapy decreased the severity of complaints more and had a higher global perceived effect compared to continued treatment by the general practitioner. Differences in effectiveness between physiotherapy and manual therapy could not be shown. A substantial part of the effect of manual therapy and physiotherapy appeared to be due to nonspecific (placebo) effects.

The effectiveness of manual therapy, physiotherapy and continued treatment by the general practitioner for chronic nonspecific back and neck complaints: design of a randomized clinical trial.

There are strong arguments for publishing research protocols before the results are available. First, it permits a critical judgment of the design unbiased by knowledge of the results, and second it may prevent publication bias. We present the design of a randomized trial on the effectiveness of manual therapy, physiotherapy, (continued) treatment by the general practitioner and a placebo treatment for patients (n = 300) with chronic (more than 6 wk) nonspecific back and neck complaints. In designing this trial in close cooperation with manual therapists and physiotherapists, special attention has been given to inclusion and exclusion criteria, (blinded) outcome measurements and control (placebo) treatment(s). Outcome measures include severity of complaints rated by a blinded research assistant, global perceived effect assessed by the patient, pain severity, functional status, range of motion (ROM) of the spine and recurrence. Measurements are carried out at baseline and after 3 wk, 6 wk, 3 months, 6 months and 1 yr.