Spinal manipulation therapy effective for back-related leg pain

1. This study suggests that spinal manipulation therapy (SMT) in addition to home exercise and advice (HEA) for the treatment of sub-acute and chronic back-related leg pain (BRLP) is effective in improving objective as well as patient-reported outcomes.

2. SMT was also associated a reduction in medication use for symptom management.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Compared to lower back pain (LBP) alone, BRLP is associated with poorer prognosis, worse quality of life, and increased cost. Little evidence exists for the effectiveness of medical or surgical approaches for BRLP. Building on research demonstrating that SMT is a low-risk strategy for improving BRLP, the present study sought to determine if SMT added to HEA would be more effective than HEA alone for sub-acute and chronic BRLP. In this trial, 192 patients were randomized to either receive SMT from chiropractic providers in addition to HEA, or HEA alone. Patients receiving both SMA and HEA reported lower patient-rated leg pain at 12 weeks compared to HEA alone. However, the difference was not sustained by 52 weeks. Still, secondary outcomes of global improvement, satisfaction, and medication use remained improved at 52 weeks for the SMT plus HEA group. Overall, these results suggest that SMT in addition to HEA is a viable conservative therapy option for treatment of BRLP. Study limitations include the inability to blind participants to the therapies and the use of non-study therapies by participants. Strengths of the study include the pragmatic design and wide age range of participant.

Click to read the study, published today in the Annals of Internal Medicine

Relevant Reading: Patients with low back pain differ from those who also have leg pain or signs of nerve root involvement – a cross-sectional study

In-Depth [randomized controlled trial]: 192 participants were randomized to receive SMT plus HEA or HEA alone. The HEA group received instruction through four 1-hour, one-on-one visits during the 12-week intervention period. The SMT plus HEA group additionally received as many as 20 SMT visits. Self-reported primary and secondary outcomes were collected at baseline, 3, 12, 26, and 52 weeks via questionnaires. 191 (99%) and 179 (93%) participants provided follow-up data at 12 and 52 weeks, respectively. On the basis of adjusted means for the primary outcome of patient-rated leg pain, patients SMT plus HEA reported significantly less pain (10 percentage points less). This difference was not sustained at 52 weeks. Secondary outcomes at 12 weeks were improved in the SMT plus HEA group compared to HEA alone for LBP, disability, physical component score, global improvement, and satisfaction. By 52 weeks, secondary outcomes remaining significantly improved in the SMT plus HEA group were global improvement and satisfaction. There was no significant difference for mental health component at either 12 or 52 weeks. The odds of the SMT plus HEA group having fewer versus more medication days was 1.8 times that of the HEA group alone at 12 weeks and 2.6 at 52 weeks.

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