Brønfort,Hondras,Hurwitz,Licciardone,Muller,Paatelma,Pope (Essay Sample)

Brønfort 1996
Bronfort et al (1996) study the relative efficacy of 3 different treatments for chronic low back pain. For this purpose, the study is using 2 pre-planned comparisons that include spinal manipulative therapy with trunk strengthening exercises versus the combination of SMT with trunk stretching exercises. It also includes the combination of SMT with TSE versus nonsteroidal anti-inflammatory drug therapy combined with TSE. The sample of 174 patients is selected in this study with the age range from 20 to 60 years. The authors conducted randomized controlled trial using Numerical Rating Scale (NRS) to assess the severity of pain in patients with chronic low back pain. It is found in the study that 5 weeks of SMT therapy combined with trunk exercise were followed by additional 6th week of exercise only. The participants were randomized allocated to one of three groups namely SMT with strengthening exercise, SMT with stretching exercise and NSAID with strengthening exercise. The main questions of the study through trial were predicated on group comparisons after fifth and eleventh week of intervention. The study provided that the three regimens selected were associated with the improvement related to the pain. Spinal manipulation was statistically significantly more effective compared with the group of therapies judged to be ineffective or perhaps harmful on short-term pain relief (4 mm; 95% CI 0–8). In terms of patient-rated pain, SMT with strengthening exercise is similar in effect to prescription nonsteroidal anti-inflammatory drugs with exercise in both the short term and long term. However, the study is not providing any advantage of strengthening over stretching exercise in combination with SMT apart from the improved trunk muscle performance. There is no mention of attempts to blind the patients to other interventions or their perceptions of potential effectiveness of the different interventions. The patients who retained at 5 weeks group.1 - 87% (62/71); group.2 - 85% (44/52); group.3 -82% (42/51). At 11 weeks: group.1 - 79% (56/71); group.2 - 77% (40/52); group.3 - 71% (36/51). After one year 28% of the subjects were lost to follow-up evaluation. This slightly exceeds the criterion of 10% to 20% loss to follow-up evaluation used to assess randomized controlled trials of manipulation for back pain (Koes et al., 1995)
Hondras 2009
Hondras et al. (2009) compared two types of manual therapy techniques within average age groups of 63.1 year olds in both genders. A sample size of 240 patients of chronics with non-radiating pain to the leg LBP participated in this study. A randomized trial was done and subjects were divided into three groups of SMT, SMOBT, and minimal limit of medical care. Participants receiving SMT or mobilisation were allowed to receive a maximum of 12 visits (not to exceed 3 times per week for the first 2 weeks, 2 times per week for the third and fourth weeks, and once per week during weeks 5 and 6) versus 3 visits of medical care.The outcomes of the study were assessed at baseline, week 3 and week 6, which were considered as post intervention, although assessment was considered at weeks 12 and 24 as follow-up assessment by computer-assisted telephone interviews by trained interviewers. The total duration of study was six months. No significant difference could be found in pain intensity between spinal manipulation and medical care (exercise, bed rest, analgesics). Mean VAS score difference between high velocity manipulation and usual care was 4.0 (95% CI: −4.0, 12.0).A total of 21 side-effects were reported by 20 participants - all resolved within 6 days and none required referral for outside care, although one participant from the medical group was referred for slurred speech. Side-effects were similar in the SMT and SMOBT groups and consisted mostly of LBP soreness and stiffness. The authors of the study selected were interested in potentials of side effects reflected in each form of SM. There were fewer side effects and adverse events in older patients in the study. The disadvantages in this regard are not evident in the study under consideration neither age factor of patients contributed in creating differences in the results (Hondras, et al., 2009). The observed limitation of this study was the drop-out rate of patients in the group which were treated by the conservative medical care. This figure grew to 36% of 49 participants who never completed the medical course. By contrast, only 0.02% of 96 and 0.09% of 95 patients did not complete the treatment in the MST and SMOBT groups respectively. It has been observed that the follow-up assessment used in this study was indirect assessment and it is considered a second limitation.
Hsieh, 2002
A sample of a total of 206 patients was studied in a randomized, assessor-blinded clinical trial. The duration of this trial was for six months, although the patients' outcomes were evaluated after three weeks and six months. This study contained four groups and was treated by a back school programme for 20 - 30 minute session once per week for a total of 3 weeks for the first group, whereas myofascial therapy, manipulation and its combination were given to the second, third and fourth groups respectively for 3 sessions per week for three weeks. In this study, three interventional groups were given treatment under the supervision of physiotherapists in clinical set ups, whereas, in the back school group, treatment was given in the form of booklet for home exercises and was not supervised by any experts. The patients received assessments at baseline after three weeks of receiving therapy and twenty-four weeks after the therapy is completed. The results of the study evidenced that spine manipulation was effective in the reduction of pain for patients suffering from chronic low back pain. It is also found that no significant advantage for SMT over myofascial therapy and for back school over SMT in terms of pain reduction. All groups showed significant improvement in pain following 3 weeks of care, but did not show further improvement at 6 months. Combined joint manipulation and myofascial therapy was as effective as joint manipulation or myofascial therapy alone. There was high risk in term of disconcordant compliance across the different therapies. Full compliance was noted for 90% (47/52) treated patients in the combined therapy group, 88% (43/49) treated patients in the joint manipulation group, 92% (47/51) treated patients in the myofascial therapy group, and 69% (33/48) treated patients in the back school group. The back school group was the least compliant.
Hurwitz 2002
Hurwitz et al. (2002) in a RCT examined the interventional outcomes of combination SMT with physiotherapy modalities and analgesics treatment for LBP patients. In this study they included a sample size of 681 patients of chronic LBP. The interventional duration of the study was for six weeks. However, the patient's pain was assessed after two and six weeks and a final evaluation was done at the end of 18 months to see the follow-up effect. The total duration of the study was 18 months. The results of the study provide that the medical care and spinal manipulation therapy without physical therapy or physical modalities reflected same improvements in pain severity using numerical rating scales. In terms of short- and long-term patient-rated pain and disability, there is strong evidence that SMT is similar in effect to a combination of medical care with exercise or exercise instruction, the intermediate-term posttreatment differences between the manipulation and medical care groups were clinically negligible (NRS-11: −0.02, 95% CI:−0.69, 0.65). Adding the use of physical modalities (hot/cold, ultrasound and electrotherapy) to SMT did not improve any outcomes. This study was conducted in a private care clinic; generalization of these results to patients in other socio-economic status should be further reviewed. Medical providers, chiropractors, and physical therapists outside this network may differ in their approaches to low back pain care; and patients under fee-for-service, workers' compensation, personal injury, and other reimbursement models may differ in ways that affect treatment outcomes. Also, patients who chose not to be randomly assigned may differ from participants on factors that modify treatment effects. Nevertheless, our study population is similar to other outpatient low back pain populations in terms of average baseline level of back pain and baseline level of disability resulting from back pain However, differences on other unmeasured factors and treatment effects that may be relatively larger in certain patient subgroups could potentially limit the study's generalizability
Licciardone 2003
Study by Licciardone et al. (2003) assessed 91 patients who were randomly allocated to three different groups of treatment: SMT, sham SMT and no-intervention. The mean age of the sample size was 49 years, and they ranged from 21 to 69 years. The total duration of the treatment was six months. Osteopathic and sham manipulation subjects were treated for a total of seven visits over5 months, including visits at 1 week, 2 weeks, and 1 month after baseline assessment, and then monthly. This study demonstrates significantly different trends over time among the treatment groups with regard to visual analog scale scores for back pain. Patients who received SMT and sham SMT showed significant improvements compared to patients in the non-intervention group at 1 (P _ 0.01 and P _ 0.003, respectively), 3 (P _ 0.001 and P _ 0.01, respectively), and 6 (P _ 0.02 and P _ 0.02, respectively) months.. SMT did not appear to have a significant advantage over sham SMT. In this study cou...