The Study: Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation
- The authors indicate there is little research to guide our treatment of back related leg pain.
- The authors wished to compare spinal manipulation combined with home exercise and advice, to care which consisted of only home exercise and advise. (In other words one group got home exercise and advice and the other group had spinal manipulation added to that care.)
- The subjects in the study were 21 or older.
- The time period in which patients could be treated was 12 weeks.
- Subjects had suffered from back-related leg pains for a minimum of 4 weeks.
- Subjects attended 4 home exercise and advice training sessions.
- The group who received spinal manipulation could have up to 20 manipulations in the 12 week period.
- The patients rated their leg pain at 12 and 52 weeks as the primary outcome.
- For secondary outcomes the patients also rated their "low-back pain, disability, global improvement, satisfaction, medication use and general health status" at the 12 and 52 week intervals.
- Subjects that received the spinal manipulation along with the exercise and advice they showed greater improvement at the 12 week time period.
- However, they only sustained better improvement at the 52 week time period in the areas of global improvement, satisfaction and using less medication.
The addition of spinal manipulation resulted in better short term outcomes ( at 12 weeks. However, differences in improvement for the manipulation group were less pronounced at the 52 week time period.
The patients received care through the use of spinal manipulation for up to 20 manipulations over a 12 week period. The home exercise and advice that both groups received could be continued by the patient at home for the whole 52 week period. At 12 weeks the group that also received the manipulation did better but the difference in the improvement for the manipulation and non manipulation groups had decreased by the end of the 52 week study period. This makes sense to me in that time tends to decrease the effect of pretty much any therapy. That's pretty much how life works. The further we get from the time we stopped dieting, the less the diet's effect. The further we get away from the time we last exercised, the less the exercise's effect.
Conversely, I think this study lends support to the thought of having patients seek chiropractic care again when they have a return of symptoms or better yet when their attending doctor of chiropractic feels that they need their next appointment. Our medical colleagues might well advise someone who had discontinued their medication, to resume taking should their symptoms return some months after their last dose. So it might be appropriate for patients for whom spinal manipulation was helpful to return for more of the same if in some months their pain returned. To me this study reinforces the concept that patients need to work with their doctor of chiropractic to receive care that is individualized for that patient.
Reviewer: Roger Coleman DC
Reference: Bronfort, G, Hondras MA, Schmulz CA, Evans RL, Long CR, Grimm R. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation. Ann Intern Med. 2014;161:381-91.
Link to Abstract: http://www.ncbi.nlm.nih.gov/pubmed/25222385