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Immediate effects of region-specific and non-region-specific spinal manipulative therapy in patients with chronic low back pain: a randomized controlled trial
de Oliveira RF, Liebano RE, Costa LCM, Rissato LL, Costa LOP
Physical Therapy 2013 Jun;93(6):748-756
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; 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*

BACKGROUND: Manual therapists typically advocate the need for a detailed clinical examination in order to decide which vertebral level should be manipulated in patients with low back pain. However, it is unclear if spinal manipulation needs to be specific to a vertebral level. OBJECTIVES: To analyze the immediate effects of a single, region specific spinal manipulation defined during the clinical examination versus a single non region specific spinal manipulation (applied on a upper thoracic vertebrae) in patients with chronic nonspecific low back pain for the outcomes pain intensity and pressure pain threshold at the time of the assessment. PARTICIPANTS: Patients with chronic non-specific low back pain (with pain duration of at least 12 weeks). RANDOMIZATION: The randomization schedule was generated by an independent statistician and was concealed by using consecutive numbered sealed opaque envelopes. INTERVENTIONS: A single high-velocity manipulation was administered to the upper thoracic region of the patients allocated to the "non region specific manipulation" group and to the painful lumbar levels of the patients allocated to the "region specific manipulation" group. BLINDING: The assessor who collected the data was blinded to the group allocation. It was not possible to blind the therapist and patients. RESULTS: A total of 148 patients participated in the study (74 in each group). There was no loss of follow up. Both groups improved in terms of immediate decrease of pain intensity, however no between-group differences were observed. The between-group difference for pain intensity and pressure pain threshold were 0.50 points (95% CI -0.10 to 1.10; p = 0.10) and -1.78 points (95% CI -6.40 to 2.82, p = 0.44), respectively. ADVERSE REACTIONS: No adverse reactions were observed. CONCLUSIONS: The immediate changes in pain intensity and pressure pain threshold after a single high-velocity manipulation do not differ by region specific versus non- region specific manipulation techniques in patients with chronic low back pain.

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