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| Orthopaedic manual therapy, McKenzie method or advice only for low back pain in working adults: a randomized controlled trial with one year follow-up |
| Paatelma M, Kilpikoski S, Simonen R, Heinonen A, Alen M, Videman T |
| Journal of Rehabilitation Medicine 2008 Nov;40(10):858-863 |
| clinical trial |
| 7/10 [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: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
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OBJECTIVE: To examine the effects of 2 manual therapy methods compared with one counselling session with a physiotherapist with 'advice-only to stay active' for treating low back pain/leg pain and disability. DESIGN: A randomized, controlled trial with a 1-year follow-up. SUBJECTS: A total of 134 subjects with low back disorders. METHODS: Participants with acute to chronic first or recurrent low back pain, excluding those with 'red flag' criteria, were assigned randomly to one of the 3 intervention groups: an orthopaedic manual therapy group (n = 45), a McKenzie method group (n = 52), and an 'advice only to be active' group (advice-only) (n = 37). Data on leg and low back pain intensity and disability (Roland-Morris Disability questionnaire) were collected at baseline, and at 3-, 6-, and 12-month follow-up points. RESULTS: At the 3-month follow-up point, significant improvements had occurred in all groups in leg and low back pain and in the disability index, but with no significant differences between the groups. At the 6-month follow-up, leg pain (15 mm; 95% confidence interval (CI) 30 to 1), back pain (effect: 15 mm; 27 to 4), and disability index (4 points; 7 to 1) improved (p < 0.05) more in the McKenzie method group than in the advice-only group. At the 1-year follow-up, the McKenzie method group had (p = 0.028) a better disability index (3 points; 6 to 0) than did the advice- only group. In the orthopaedic manual therapy group at the 6-month and 1-year follow-up visits, improvements in the pain and disability index were somewhat better than in the advice-only group (p = 0.067 and 0.068, respectively). No differences emerged between the orthopaedic manual therapy and McKenzie method groups in pain- and disability-score changes at any follow-up. CONCLUSION: The orthopaedic manual therapy and McKenzie methods seemed to be only marginally more effective than was one session of assessment and advice-only.
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