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The immediate effect of sustained natural apophyseal glide on postural stability and pain in individuals presenting with flexion-dominant chronic low back pain: a randomized single-blinded placebo-controlled trial
Hussein HM, Morsi AA, Abdelraoof NA
Journal of Back and Musculoskeletal Rehabilitation 2021;34(6):1079-1086
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: Yes; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; 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*

BACKGROUND: Low back pain (LBP) is a common musculoskeletal problem, which commonly affects balance. Sustained natural apophyseal glide (SNAG) is a successful treatment approach for LPB. However, its influence on balance problems has not been studied before. OBJECTIVE: To investigate the immediate effect of SNAG on postural stability and pain in individuals with flexion-dominant chronic low back pain (FCLBP). METHODS: Randomized placebo-controlled trial in which 64 participants with FCLBP were randomly allocated into two groups (SNAG and sham). SNAG group (n = 32) received central lumbar SNAG on the symptomatic lumbar level(s). Sham group (n = 32) received sham SNAG. The outcome measures were postural stability indices; overall stability index (OSI), anteroposterior stability index (APSI), and mediolateral stability index (MLSI) in addition to pain intensity. Outcomes were assessed using the Biodex Balance System and visual analog scale respectively. Measures were taken before and immediately after interventions. RESULTS: There were statistical significance and high effect size (ES) in favor of the SNAG group regarding OSI, APSI, and pain (p < 0.01, cohen's d ES 1.3, 1.4, 1.1 respectively). MLSI showed moderate ES (Cohen's d = 0.7) but did not reach a statistically significant level (p = 0.05). CONCLUSION: Lumbar SNAG produces an immediate improvement in postural stability and pain in individuals with FCLBP.

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