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Manual therapy with steroid injections in low-back pain. Improvement of quality of life in a controlled trial with four months' follow-up
Blomberg S, Svardsudd K, Tibblin G
Scandinavian Journal of Primary Health Care 1993 Jun;11(2):83-90
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To compare prospectively the effect of manual treatment such as manipulation, specific mobilization, muscle stretching, auto-traction, and cortisone injections with standardized conventional but optimized activating treatment by primary health care teams. DESIGN: Prospective controlled multicentre trial with four months' follow-up. SETTING: Kopparberg County, Sweden. Six primary health care or occupational health care centres, representing a catchment area of 56000 residents participated. PARTICIPANTS: 101 outpatients with acute or subacute low-back pain were, during the period February 1988 to April 1989, randomly allocated to one of two treatment groups. MAIN OUTCOME MEASURE: Quality of life was assessed at baseline and at four months by means of visual analogue scales (VAS). The occurrence of 27 different symptoms of a psychosomatic character was surveyed initially and at four months by questions answered by "yes" or "no" in a questionnaire. RESULTS: There were significant differences concerning quality of life and presence of general symptoms in favour of the group receiving manual treatment with steroid injections. CONCLUSION: Manual treatment with steroid injections was superior to conventional treatment in minimizing mental and somatic symptoms and increasing quality of life, in parallel with other measures of improvement.

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