A Randomized Clinical Trial Comparing Chiropractic Adjustments to Muscle Relaxants for Subacute Low Back Pain

Hoiriis, Kathryn T.; Pfleger, Bruce; McDuffie, Frederic C.; Cotsonis, George; Elsangak, Omar; Hinson, Roger A.; Verzosa, Gregoria T.

doi:10.1016/j.jmpt.2004.05.003

Cited by 77 publications

(65 citation statements)

References 38 publications

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“…A detailed summary of these updated findings, as well as the strength of their evidence and level of agreement with existing studies, are presented in Table 4. 7,30,[35][36][37][38]41,43,45 In comparison to recent SRs, 36,41,43,45 the present results highlight a number of new issues in the management of LBP with MT: Firstly, in comparison to previous reports of limitedevidence 41,43 showing no-difference between true and sham manipulation, the results of this SR show moderate to strong evidence [57][58][59]62,63 for the beneficial effects of MT1 in comparison to sham-MT1. These differences are demonstrated in terms of pain relief, functional improvement, and overall-health and quality of life improvements in the short-term for all stages of LBP.…”

Section: Discussionsupporting

confidence: 50%

“…Moreover, researchers need to conceptualize placebo not only as a comparative inert intervention, but also as a potential mechanism to partially account for treatment effects associated with MT. 68 In the present SR, only five studies were placebo-controlled, four of them using sham adjustment, 31,57,58,62,63 while one used a real manipulation at the incorrect spinal level to achieve an authentic placebo response. 59 Further research is required to identify a plausible placebo response.…”

Section: Discussionmentioning

confidence: 94%

“…MT versus sham-MT Santilli et al, 57 Hoiriis et al, 58 and von Heymann et al 59 (studies rated as level A quality) assessed the effects of MT1 in comparison to sham-MT1 in patients with acute LBP. Santilli et al 57 compared lumbo-pelvic rotational manipulation toward the pain-free direction to simulated manipulation not following any specific pattern and not involving rapid thrust.…”

Section: Effects Of Interventions On Acute and Subacute Lbpmentioning

confidence: 99%

“…Two patients, one in MT1 and one in sham-MT1, were dissatisfied with treatment and stopped. Hoiriis et al 58 investigated the effects of lumbopelvic manipulation in prone or side-lying position combined with a drug placebo, in comparison to sham-MT1 combined with a muscle relaxant or with a drug placebo. Sham-MT1 consisted of manual light pressure on the lumbar spine in both positions (prone and side-lying).…”

Section: Effects Of Interventions On Acute and Subacute Lbpmentioning

confidence: 99%

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The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews

Hidalgo

Detrembleur

Hall

et al. 2013

Journal of Manual & Manipulative Therapy

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Objective: to review and update the evidence for different forms of manual therapy (MT) for patients with different stages of non-specific low back pain (LBP). Data sources: MEDLINE, Cochrane-Register-of-Controlled-Trials, PEDro, EMBASE. Method: A systematic review of MT with a literature search covering the period of January 2000 to April 2013 was conducted by two independent reviewers according to Cochrane and PRISMA guidelines. A total of 360 studies were evaluated using qualitative criteria. Two stages of LBP were categorized; combined acute-subacute and chronic. Further sub-classification was made according to MT intervention: MT1 (manipulation); MT2 (mobilization and soft-tissue-techniques); and MT3 (MT1 combined with MT2). In each sub-category, MT could be combined or not with exercise or usual medical care (UMC). Consequently, quantitative evaluation criteria were applied to 56 eligible randomized controlled trials (RCTs), and hence 23 low-risk of bias RCTs were identified for review. Only studies providing new updated information (11/23 RCTs) are presented here. Results: Acute-subacute LBP: STRONG-evidence in favour of MT1 when compared to sham for pain, function and health improvements in the short-term (1-3 months). MODERATE-evidence to support MT1 and MT3 combined with UMC in comparison to UMC alone for pain, function and health improvements in the short-term. Chronic LBP: MODERATE to STRONG-evidence in favour of MT1 in comparison to sham for pain, function and overall-health in the short-term. MODERATE-evidence in favour of MT3 combined with exercise or UMC in comparison to exercise and back-school was established for pain, function and quality-of-life in the short and long-term. LIMITED-evidence in favour of MT2 combined with exercise and UMC in comparison to UMC alone for pain and function from short to long-term. LIMITED-evidence of no effect for MT1 with extension-exercise compared to extension-exercise alone for pain in the short to long-term. Conclusion: This systematic review updates the evidence for MT with exercise or UMC for different stages of LBP and provides recommendations for future studies.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 94%

Section: Effects Of Interventions On Acute and Subacute Lbpmentioning

confidence: 99%

Section: Effects Of Interventions On Acute and Subacute Lbpmentioning

confidence: 99%

See 2 more Smart Citations

The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews

Hidalgo

Detrembleur

Hall

et al. 2013

Journal of Manual & Manipulative Therapy

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“…Hoiriis et al [72] Positioning and light pressure hFi Belief in provision of true chiropractic adjustments: more patients in chiropractic group believed real adjustments were provided (P \ 0.001)…”

mentioning

confidence: 99%

Imperfect placebos are common in low back pain trials: a systematic review of the literature

et al. 2008

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The placebo is an important tool to blind patients to treatment allocation and therefore minimise some sources of bias in clinical trials. However, placebos that are improperly designed or implemented may introduce bias into trials. The purpose of this systematic review was to evaluate the adequacy of placebo interventions used in low back pain trials. Electronic databases were searched systematically for randomised placebo-controlled trials of conservative interventions for low back pain. Trial selection and data extraction were performed by two reviewers independently. A total of 126 trials using over 25 different placebo interventions were included. The strategy most commonly used to enhance blinding was the provision of structurally equivalent placebos. Adequacy of blinding was assessed in only 13% of trials. In 20% of trials the placebo intervention was a potentially genuine treatment. Most trials that assessed patients' expectations showed that the placebo generated lower expectations than the experimental intervention. Taken together, these results demonstrate that imperfect placebos are common in low back pain trials; a result suggesting that many trials provide potentially biased estimates of treatment efficacy. This finding has implications for the interpretation of published trials and the design of future trials. Implementation of strategies to facilitate blinding and balance expectations in randomised groups need a higher priority in low back pain research.

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Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain

Paige

Miake-Lye

Booth

et al. 2017

JAMA

176

112

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A Randomized Clinical Trial Comparing Chiropractic Adjustments to Muscle Relaxants for Subacute Low Back Pain

Cited by 77 publications

References 38 publications

The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews

The efficacy of manual therapy and exercise for different stages of non-specific low back pain: an update of systematic reviews

Imperfect placebos are common in low back pain trials: a systematic review of the literature

Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain

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