Maintained SMT, LBP, and Long Term Outcomes

Senna MK and Machaly SA. Does Maintained Spinal Manipulation Therapy for Chronic Nonspecific Low Back Pain Result in Better Long-Term Outcome? Spine 2011

  • A prospective single blinded placebo controlled study to assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic nonspecific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels after an initial phase of treatments.
  • Although previous studies have mostly investigated the short term effects of SMT, several studies indicated that as duration of SMT persisted, symptom reduction and function continue to improve as well. The authors hypothesized that if SMT can be maintained for longer periods, it will be more beneficial in maintaining the desirable outcomes obtained after short-term treatment
  • Eligible subjects were patients aging between 20 and 60 years with chronic nonspecific LBP (that lasted for at least 6 months). A total of 154 patients were examined, 61 patients were excluded whereas 93 patients were eligible and enrolled in this study. Patients with “red flags” for a serious spinal condition were excluded.
  • Patients who were manipulated by one physician were assessed throughout all the trial follow-up intervals by the other physician who was completely blind to group assignment of patients being assessed.
  • The first group received 12 treatments consisting of sham SM using minimal force over a 1-month period (control group), but no treatments for the subsequent 9 months. The second group received 12 treatments consisting of standardized SM three times weekly over a 1-month period, but no treatments for the subsequent 9 months (nonmaintained SMT group). The third group also received same intensive treatment of SM as second group over a 1-month period “initial intensive SMT,” along with “maintenance SMT” every 2 weeks for the next 9 months (maintained SMT group)
  • Patients in group 2 and 3 exhibited significantly lower pain (VAS), disability scores (Oswestry, SF-36), and spine ROM scores compared with control group after 1st month. After 2nd month, pts in maintained SMT group had significantly lower pain and disability scores compared to the nonmaintained group. Most scores in nonmaintained group gradually returned close to baseline pre-treatment levels. 
  • SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative treatment duration.