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A benefit of spinal manipulation as adjunctive therapy for acute low-back pain: a stratified controlled trial
Hadler NM, Curtis P, Gillings DB, Stinnett S
Spine 1987 Sep;12(7):703-706
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; 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*

Fifty-four subjects volunteered to participate in a controlled study contrasting spinal manipulation with spinal mobilization without the rotational forces and leverage required to move facet joints. All suffered from regional low-back pain for less than 1 month, were ages 18 to 40, had never previously undergone any form of spinal manipulation, and denied a prior episode of backache within the previous 6 months. Randomization was stratified at outset into those who suffered for less than 2 weeks and those whose discomfort had persisted for 2 to 4 weeks. Outcome was monitored by a questionnaire assessing functional impairment. A treatment effect of manipulation was demonstrated only in the strata with more prolonged illness at entry. In the first week following manipulation, these patients improved to a greater degree (p = 0.009, t test) and more rapidly (p < 0.025, Wilcoxon rank-sum test).
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