Physiotherapy Based on a Biobehavioral Approach with or Without Orthopedic Manual Physical Therapy in the Treatment of Nonspecific Chronic Low Back Pain: A Randomized Controlled Trial

Abstract

Objective To compare the effectiveness of a biobehavioral approach with and without orthopedic manual physical therapy on the intensity and frequency of pain in patients diagnosed with nonspecific chronic low back pain. Methods A single-blind randomized controlled trial. Fifty patients were randomly allocated into two groups: one group received biobehavioral therapy with orthopedic manual physical therapy, and the other group received only biobehavioral therapy. Both groups completed a total of eight sessions, with a frequency of two sessions per week. The somatosensory, physical, and psychological variables were recorded at baseline and during the first and third month after initiation of treatment. Results In both groups, the treatment was effective, presenting significant differences for all the variables in the time factor. There were no significant differences between groups in intensity or frequency of pain, with a large effect size (>0.80), but there were intragroup differences for both intervention groups at one- and three-month follow-up. There were also no significant differences between groups in the secondary variables during the same follow-up period. Conclusions The results of this study suggest that orthopedic manual physical therapy does not increase the effects of a treatment based on biobehavioral therapy in the short or medium term, but these results should be interpreted with caution.

The effect of spinal manipulative therapy on pain relief and function in patients with chronic low back pain: an individual participant data meta-analysis

“…This was new trials (5) , all of which were small in size and considered to have a high risk of bias. A update search from May 2018 until October 2020 identified five studies (13)(14)(15)(16)(17) , three of which are small in size. The two larger studies examining SMT versus recommended and SMT as adjuvant therapy reported similar results to ours.…”

Relationship between healthcare seeking and pain expansion in patients with nonspecific chronic low back pain

“…Several structures in the back, including the joints, discs and connective tissues, may contribute to symptoms'' (Savigny, Watson & Underwood, 2009). The following inclusion criteria were also considered on the basis of a previous investigation (Grande-Alonso et al, 2019): (a) LBP for at least the prior 3 months; (b) LBP of a nonspecific nature; (c) men and women aged 18 to 65 years (Carmona et al, 2001); (d) LBP for at least 10 days per month (Goubert, Danneels & Graven-nielsen, 2017); the time between seeking care and recruitment was 5-7 days; and (e) an intensity of pain between 3 and 10 on the visual analogue scale (VAS).…”

“…Frequency of medication. The frequency of medication was evaluated based on the number of days the patient had taken medication for LBP in the last month (Grande-Alonso et al, 2019).…”

Correct Sciatic Nerve Management to Apply Ultrasound-Guided Percutaneous Neuromodulation in Patients With Chronic Low Back Pain: A Pilot Study

“…The inclusion criteria were: 1) to have had LBP for at least the prior six months (28); 2) LBP of a nonspecific nature (28); 3) to be aged 18–65 years (29); 4) to suffer pain intensity of between 3 and 10 on the visual analogue scale (30); and 5) to have one hip with limited active internal rotation, measured by goniometer (31). The exclusion criteria were: 1) to have peripheral pain (like a sciatic pain); 2) the presence of neurological signs or muscular dystrophy, systemic rheumatic disease or central nervous system disease (32); 3) electrophysiological findings referable to another peripheral nerve; 4) any previous surgery or acute trauma in the trunk or lower extremity; 5) commonly accepted contraindications to invasive physical therapy techniques (21); 6) any contraindications to needling per se (21); and 7) epilepsy.…”