Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial
The Spine Journal, 08/10/2011
Bronfort G et al. – For chronic low back pain (CLBP), supervised exercise was significantly better than chiropractic spinal manipulation and home exercise in terms of satisfaction with treatment and trunk muscle endurance and strength. Although the short– and long–term differences between groups in patient–rated pain, disability, improvement, general health status, and medication use consistently favored the supervised exercise group, the differences were relatively small and not statistically significant for these individual outcomes.Methods
- An observer–blinded and mixed–method randomized clinical trial conducted in a university research clinic in Bloomington, MN, USA.
- Individuals, 18 to 65 years of age, who had a primary complaint of mechanical LBP of at least 6–week duration with or without radiating pain to the lower extremity were included in this trial.
- This prospective randomized clinical trial examined the short– (12 weeks) and long–term (52 weeks) relative efficacy of high–dose, supervised low–tech trunk exercise, chiropractic SMT, and a short course of home exercise and self–care advice for the treatment of LBP of at least 6–week duration.
- The study was approved by local institutional review boards.
- A total of 301 individuals were included in this trial.
- For all three treatment groups, outcomes improved during the 12 weeks of treatment.
- Those who received supervised trunk exercise were most satisfied with care and experienced the greatest gains in trunk muscle endurance and strength, but they did not significantly differ from those receiving chiropractic spinal manipulation or home exercise in terms of pain and other patient–rated individual outcomes, in both the short– and long–term.