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No differences in outcomes in people with low back pain who met the clinical prediction rule for lumbar spine manipulation when a pragmatic non-thrust manipulation was used as the comparator
Learman K, Showalter C, O'Halloran B, Donaldson M, Cook C
Physiotherapy Canada 2014 Spring;66(4):359-366
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

PURPOSE: To investigate differences in pain and disability between patients treated with thrust manipulation (TM) and those treated with non-thrust manipulation (NTM) in a group of patients with mechanical low back pain (LBP) who had a within-session response to an initial assessment and met the clinical prediction rule (CPR). METHODS: Data from 71 patients who met the CPR were extracted from a database of patients in a larger randomized controlled trial comparing TM and NTM. Treatment of the first two visits involved either TM or NTM (depending on allocation) and a standardized home exercise programme. Data analysis included descriptive statistics and a two-way ANOVA examining within- and between-groups effects for pain and disability, as well as total visits, total days in care, and rate of recovery. RESULTS: No between-group differences in pain or disability were found for NTM versus TM groups (p = 0.55), but within-subjects effects were noted for both groups (p < 0.001). CONCLUSIONS: This secondary analysis suggests that patients who satisfy the CPR benefit as much from NTM as from TM.

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