Spinal Manipulative Therapy versus Active Exercise Therapy for chronic lower back pain: A randomized clinical trial with subgroup analyses

BACKGROUND:

There are conflicting data on the effectiveness of spinal manipulative therapy (SMT) and active exercise therapy (AET) in the treatment of patients suffering from chronic low back pain (CLBP). Recent studies have attempted to identify patient characteristics which may predict which treatment intervention will be most effective for CLBP. The purpose of the study is to test the impact of a previously validated subset of patient individual characteristics (emotional response to pain, pain location and physical exam findings) as predictors of the effectiveness of SMT and AET in CLBP sufferers.

METHODS:

Patients are being randomized into one of two groups based on these individual characteristics and then randomized to receive either SMT or AET. Intervention will consist of eight treatments over a thirty day period. Outcome measures will then be collected immediately post-intervention, three months and six months post-intervention. Outcome measures include Visual Analogue Scale, Oswestry Disability Index and Short Form-36. Adverse event and patient satisfaction data will also be collected and analyzed.

RESULTS: This federally funded study (HRSA R18HP07641)is currently underway. Preliminary data will be presented at the meeting including; number of patients currently recruited and preliminary outcome data.

DISCUSSION:

The purpose of this study is to identify characteristics of patients that may benefit from either SMT or AET. The identification by healthcare providers of specific predictive characteristics in patients with CLBP has the potential to contribute to appropriate treatment selection effectively optimizing resource allocation, treatment effectiveness and cost savings.