Clinical effects of short and long lever spinal thrust manipulation in non-specific chronic low back pain: A biomechanical perspective

Nambi, Gopal; Inbasekaran, Dipika; Khuman, Ratan; Devi, Surbala; Satani, Kalpesh

doi:10.4103/2278-344x.126706

Cited by 2 publications

(1 citation statement)

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“…With chiropractic care, these interacting components may include the biomechanical characteristics of spinal or joint manipulation, the therapeutic components of chiropractic care, and the non-specific effects of health interventions in general. The biomechanical characteristics of spinal manipulation [ 4 – 8 ] are commonly described in terms of force-time profile (e.g., loading rates, peak and pre-load forces) [ 8 – 10 ] or the thrust characteristics of location, direction and duration [ 9 , 11 ]. Therapeutic components of chiropractic care may include the underlying theoretical paradigm (i.e., subluxation, biomechanical, or somatic dysfunction) [ 12 – 15 ], specific techniques applied [ 16 – 19 ], and treatment frequency or dose [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Chiropractor interaction and treatment equivalence in a pilot randomized controlled trial: an observational analysis of clinical encounter video-recordings

et al. 2014

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BackgroundChiropractic care is a complex health intervention composed of both treatment effects and non-specific, or placebo, effects. While doctor-patient interactions are a component of the non-specific effects of chiropractic, these effects are not evaluated in most clinical trials. This study aimed to: 1) develop an instrument to assess practitioner-patient interactions; 2) determine the equivalence of a chiropractor’s verbal interactions and treatment delivery for participants allocated to active or sham chiropractic groups; and 3) describe the perceptions of a treatment-masked evaluator and study participants regarding treatment group assignment.MethodsWe conducted an observational analysis of digital video-recordings derived from study visits conducted during a pilot randomized trial of conservative therapies for temporomandibular pain. A theory-based, iterative process developed the 13-item Chiropractor Interaction and Treatment Equivalence Instrument. A trained evaluator masked to treatment assignment coded video-recordings of clinical encounters between one chiropractor and multiple visits of 26 participants allocated to active or sham chiropractic treatment groups. Non-parametric statistics were calculated.ResultsThe trial ran from January 2010 to October 2011. We analyzed 111 complete video-recordings (54 active, 57 sham). Chiropractor interactions differed between the treatment groups in 7 categories. Active participants received more interactions with clinical information (8 vs. 4) or explanations (3.5 vs. 1) than sham participants within the therapeutic domain. Active participants received more directions (63 vs. 58) and adjusting instrument thrusts (41.5 vs. 23) in the procedural domain and more optimistic (2.5 vs. 0) or neutral (7.5 vs. 5) outcome statements in the treatment effectiveness domain. Active participants recorded longer visit durations (13.5 vs. 10 minutes). The evaluator correctly identified 61% of active care video-recordings as active treatments but categorized only 31% of the sham treatments correctly. Following the first treatment, 82% of active and 11% of sham participants correctly identified their treatment group. At 2-months, 93% of active and 42% of sham participants correctly identified their group assignment.ConclusionsOur findings show the feasibility of evaluating doctor-patient interactions in chiropractic clinical trials using video-recordings and standardized instrumentation. Clinical trial design and clinician training protocols should improve and assess the equivalence of doctor-patient interactions between treatment groups.Trial registrationThis trial was registered in ClinicalTrials.gov as NCT01021306 on 24 November 2009.

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Section: Introductionmentioning

confidence: 99%

Chiropractor interaction and treatment equivalence in a pilot randomized controlled trial: an observational analysis of clinical encounter video-recordings

et al. 2014

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Spinal Manipulative Therapy for Nonspecific Low Back Pain: Does Targeting a Specific Vertebral Level Make a Difference?: A Systematic Review With Meta-analysis

Sørensen

Nim

Poulsen

et al. 2023

Journal of Orthopaedic & Sports Physical Therapy

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OBJECTIVE: We aimed to examine whether targeting spinal manipulative therapy (SMT), by applying the intervention to a specific vertebral level, produces superior clinical outcomes than a nontargeted approach in patients with nonspecific low back pain. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: MEDLINE, Embase, CENTRAL, CINAHL, Scopus, PEDro, and Index to Chiropractic Literature were searched up to May 31, 2023. STUDY SELECTION CRITERIA: Randomized controlled trials comparing targeted SMT (mobilization or manipulation) to a nontargeted approach in patients with nonspecific low back pain, and measuring the effects on pain intensity and patient-reported disability. DATA SYNTHESIS: Data extraction, risk of bias, and evaluation of the overall certainty of evidence using the GRADE approach were performed by 2 authors independently. Meta-analyses were performed using the restricted maximum likelihood method. RESULTS: Ten randomized controlled trials (n = 931 patients) were included. There was moderate-certainty evidence of no difference between targeted SMT and a nontargeted approach for pain intensity at postintervention (weighted mean difference = −0.20 [95% CI: −0.51, 0.10]) and at follow-up (weighted mean difference = 0.05 [95% CI: −0.26, 0.36]). For patient-reported disability, there was moderate-certainty evidence of no difference at postintervention (standardized mean difference = −0.04 [95% CI: −0.36, 0.29]) and at follow-up (standardized mean difference = −0.05 [95% CI: −0.24, 0.13]). Adverse events were reported in 4 trials, and were minor and evenly distributed between groups. CONCLUSION: Targeting a specific vertebral level when administering SMT for patients with nonspecific low back pain did not result in improved outcomes on pain intensity and patient-reported disability compared to a nontargeted approach. J Orthop Sports Phys Ther 2023;53(9):529-539. Epub: 28 July 2023. doi:10.2519/jospt.2023.11962

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Clinical effects of short and long lever spinal thrust manipulation in non-specific chronic low back pain: A biomechanical perspective

Cited by 2 publications

References 11 publications

Chiropractor interaction and treatment equivalence in a pilot randomized controlled trial: an observational analysis of clinical encounter video-recordings

Chiropractor interaction and treatment equivalence in a pilot randomized controlled trial: an observational analysis of clinical encounter video-recordings

Spinal Manipulative Therapy for Nonspecific Low Back Pain: Does Targeting a Specific Vertebral Level Make a Difference?: A Systematic Review With Meta-analysis

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