Study Shows Manipulation / Exercise Combination
More Effective for Back Pain ...
But "Manipulation Alone Probably Gives Better Value for Money." Although
exact numbers remain elusive, it's clear that back pain and related
musculoskeletal conditions place a tremendous burden on the nation's economy.
According to some experts, these disorders account for upwards of $50
billon per year in time away from work, hospital bills, prescription
drugs and lost productivity.1
A recent study 2 conducted by the Medical Research
Council, a research organization based in the United Kingdom, has
found that patients given a combination of spinal manipulation and exercise
experienced greater improvements in back function and greater reductions in
pain compared to those treated with spinal manipulation or exercise only. These
improvements also lasted longer.
The study, published on the British Medical Journal (BMJ)
website (www.bmj.com), included more than 1,300 patients who had consulted
a general practitioner about low back pain, but whose pain had not improved.
Patients were randomized into four groups: one group was used as a control
and did not receive any other intervention; the remaining groups received one
of three forms of care; spinal manipulation, exercise, or both interventions.
Participants in all four groups completed a series of questionnaires on general
health, back pain, disability (the Roland Morris disability questionnaire and
the modified Von Korff scales), fear-avoidance beliefs, and psychological well-being
before being randomized, and at 1-, 3- and 12-month intervals.
In the exercise group "statistically significant improvements" were
seen in the Roland disability scores and the physical and fear-avoidance scores.
Similarly, patients treated with manipulation showed significant improvements
in the Von Korff disability scores and the SF-36 mental health scores. The
greatest improvements were seen in the group that received spinal manipulation
followed by exercise. This combination produced "significant improvements" in
the Roland disability scores, the Von Korff disability and pain scores, back
pain beliefs, fear-avoidance beliefs and physical questionnaires at both three
and 12 months, and improvement in mental health scores at three months.
Analysis of the Roland disability questionnaires showed just how much the combination
of manipulation and exercise could help patients regain the ability to perform
certain activities of daily living. The questionnaire contained 24 items (valued
at one point each) designed to measure functional disability due to back pain.
When comparing the results of each group, exercise helped participants perform
an average of 1.4 additional personal functions three months after the start
of the study; manipulation helped patients perform 1.6 additional functions;
and combined treatment resulted in patients being able to perform 1.9 additional
personal functions.
"We believe that this is the first study of physical therapy for low back
pain to show convincingly that both manipulation alone and manipulation followed
by exercise provide cost-effective additions to care in general practice. The
detailed clinical outcomes reported in the accompanying paper reinforce these
findings by showing that the improvements in health status reported here reflect
statistically significant improvements in function, pain, disability, physical
and mental aspects of quality of life and beliefs about back pain."
References
1. Recent study findings reinforce effectiveness of spinal manipulation, says
American Chiropractic Association. ACA press release, Nov. 29, 2004.
2. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK
BEAM) randomized trial: effectiveness of physical treatments for back pain
in primary care. BMJ Online First, Nov. 29, 2004.
3. UK BEAM Trial Team. UK BEAM Trial Team. United Kingdom back pain exercise
and manipulation (UK BEAM) randomized trial: cost-effectiveness of physical
treatments for back pain in primary care. BMJ Online First, 11-29-04.
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