Article

OBJECTIVE: To compare spinal manipulation, back school and individual
physiotherapy in the treatment of chronic low back pain.
DESIGN: Randomized
trial, 12-month follow-up. SETTING: Outpatient rehabilitation department.
PARTICIPANTS: 210 patients with chronic, non-specific low back pain, 140/210
women, age 59 +/- 14 years. INTERVENTIONS: Back school and individual
physiotherapy scheduled 15 1-hour-sessions for 3 weeks. Back school included:
group exercise, education/ ergonomics; individual physiotherapy: exercise,
passive mobilization and soft-tissue treatment. Spinal manipulation, given
according to Manual Medicine, scheduled 4 to 6 20'-sessions once-a-week. OUTCOME:
Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale
(scoring 0-6) were assessed at baseline, discharge 3, 6, and 12 months. RESULTS:
205 patients completed the study. At discharge, disability score decreased by 3.7
+/- 4.1 for back school, 4.4 +/- 3.7 for individual physiotherapy, 6.7 +/- 3.9
for manipulation; pain score reduction was 0.9 +/- 1.1, 1.1 +/- 1.0, 1.0 +/- 1.1,
respectively. At 12 months, disability score reduction was 4.2 +/- 4.8 for back
school, 4.0 +/- 5.1 for individual physiotherapy, 5.9 +/- 4.6 for manipulation;
pain score reduction was 0.7 +/- 1.2, 0.4 +/- 1.3, and 1.5 +/- 1.1, respectively.
Spinal manipulation was associated with higher functional improvement and
long-term pain relief than back school or individual physiotherapy, but received
more further treatment at follow-ups (P < 0.001);
pain recurrences and drug
intake were also reduced compared to back school
(P < 0.05) or individual
physiotherapy (P < 0.001). CONCLUSIONS: Spinal manipulation provided better short
and long-term functional improvement, and more pain relief in the follow-up than
either back school or individual physiotherapy.

Langue : ANGLAIS