STUDY DESIGN: A mulicentre assessor-blinded randomized clinical trial was conducted. OBJECTIVES: To investigate the difference in effectiveness of manipulative therapy and interferential therapy for patients with acute low back pain when used as sole treatments and in combination. SUMMARY OF BACKGROUND DATA: Both manipulative therapy and interferential therapy are commonly used treatments for low back pain. Evidence for the effectiveness of manipulative therapy is available only for the short-term. There is limited evidence for interferential therapy, and no study has investigated the effectiveness of manipulative therapy combined with interferential therapy. METHODS: Consenting subjects (n = 240) recruited following referral by physicians to physiotherapy departments in the (government-funded) National Health Service in Northern Ireland were randomly assigned to receive a copy of the Back Book and either manipulative therapy (MT; n = 80), interferential therapy (IFT; n = 80), or a combination of manipulative therapy and interferential therapy (CT; n = 80). The primary outcome was a change in functional disability on the Roland Morris Disability Questionnaire. Follow-up questionnaires were posted ay discharge and at 6 and 12 months. RESULTS: The groups were balanced at baseline for low back pain and demographic characteristics. At discharge all interventions reduced functional disability (Roland Morris scale MT -4.53; 95% CI -5.7 to -3.3 versus IFT -3.56; 95% CI 4.8 to 2.4 versus CT -4.65; 95% CI -5.8 to -3.5; p = 0.38) and pain (McGill questionnaire MT -5.12; 95% CI -7.7 to -2.5 versus IFT -5.87; 95% CI -8.5 to -3.3 versus CT -6.64; 95% CI -9.2 to -4.1; p = 0.72) and increased quality of life (SF-36 Role Physical MT 28.6, 95% CI 18.3 to 38.9 versus IFT 31.4; 95% CI 21.2 to 41.5 versus CT 30; 95% CI 19.9 to 40; p = 0.93) to the same degree and maintained these improvements at 6 and 12 months. No significant differences were found between groups for reported LBP recurrence, work absenteeism, medication consumption, exercise participation, or healthcare use at 12 months (p > 0.05). CONCLUSIONS: For acute low back pain, there was no difference between the effects of a continued manipulative therapy and interferential therapy alone.
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