Optimization of Spinal Manipulative Therapy Protocols: A Factorial Randomized Trial Within a Multiphase Optimization Framework.
Low back pain
exercise
factorial design
spinal manipulative therapy
Journal
The journal of pain
ISSN: 1528-8447
Titre abrégé: J Pain
Pays: United States
ID NLM: 100898657
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
received:
20
07
2020
revised:
23
10
2020
accepted:
11
11
2020
pubmed:
15
12
2020
medline:
27
1
2022
entrez:
14
12
2020
Statut:
ppublish
Résumé
Spinal manipulative therapy (SMT) is a common nonpharmacological treatment for low back pain (LBP). Although generally supported by systematic reviews and practice guidelines, clinical trials evaluating SMT have been characterized by small effect sizes. This study adopts a Multiphase Optimization Strategy framework to examine individual components of an SMT delivery protocol using a single-blind trial with the goal of identifying and optimizing a multicomponent SMT protocol. We enrolled 241 participants with LBP. All participants received 2 SMT treatment sessions in the first week then were randomly assigned additional treatment based on a fully factorial design. The 3 randomized treatment components provided in twice weekly sessions over 3 weeks were multifidus activating exercise, spinal mobilizing exercise, and additional SMT dose. Primary outcomes included clinical (Oswestry Disability Index, numeric pain intensity rating) and mechanistic (spinal stiffness, multifidus muscle activation) measures assessed at baseline, 1, 4, and 12 weeks. Significant differences were found for the Oswestry index after 12 weeks for participants receiving multifidus activating exercise (mean difference = -3.62, 97.5% CI: -6.89, -0.35; P= .01). There were no additional significant main or interaction effects for other treatment components or different outcome measures. The optimized SMT protocol identified in this study included SMT sessions followed by multifidus activating exercises. PERSPECTIVE: Optimizing the effects of nonpharmacological treatments such as SMT for LBP is challenging due to uncertainty regarding mechanisms and the complexity of multicomponent protocols. This factorial randomized trial examined SMT protocols provided with differing co-interventions with mechanistic and patient-centered outcomes. Patient-centered outcomes were optimized by inclusion of lumbar multifidus strengthening exercises.
Identifiants
pubmed: 33309783
pii: S1526-5900(20)30110-3
doi: 10.1016/j.jpain.2020.11.008
pmc: PMC8190177
mid: NIHMS1658968
pii:
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
655-668Subventions
Organisme : NCRR NIH HHS
ID : UL1 RR025764
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002538
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR002539
Pays : United States
Organisme : NCCIH NIH HHS
ID : UH3 AT009293
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000105
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001067
Pays : United States
Informations de copyright
Crown Copyright © 2020. Published by Elsevier Inc. All rights reserved.
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