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Optimization of Spinal Manipulative Therapy Protocols: A Factorial Randomized Trial Within a Multiphase Optimization

Julie M Fritz1, Jason Sharpe1, Tom Greene2

  • 1Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah.

The Journal of Pain
|December 14, 2020
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Summary
This summary is machine-generated.

Optimizing spinal manipulative therapy (SMT) for low back pain (LBP) involves combining SMT with multifidus activating exercises. This approach improved patient-centered outcomes in a randomized trial.

Keywords:
Low back painexercisefactorial designspinal manipulative therapy

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Area of Science:

  • Orthopedics
  • Physical Therapy
  • Rehabilitation Medicine

Background:

  • Spinal manipulative therapy (SMT) is a common nonpharmacological treatment for low back pain (LBP).
  • Clinical trials often show small effect sizes for SMT, necessitating protocol optimization.
  • Understanding the mechanisms and components of SMT is crucial for improving its efficacy.

Purpose of the Study:

  • To optimize a multicomponent spinal manipulative therapy (SMT) protocol for low back pain (LBP) using a Multiphase Optimization Strategy.
  • To identify which components of SMT delivery, including exercises and additional SMT, most effectively improve patient outcomes.
  • To evaluate both clinical and mechanistic outcomes to understand the effects of different SMT protocol variations.

Main Methods:

  • A single-blind, fully factorial randomized trial design was employed with 241 participants experiencing LBP.
  • Participants received initial SMT sessions, followed by randomization to receive combinations of multifidus activating exercise, spinal mobilizing exercise, and additional SMT.
  • Outcomes including the Oswestry Disability Index, pain intensity, spinal stiffness, and multifidus muscle activation were assessed over 12 weeks.

Main Results:

  • Inclusion of multifidus activating exercise in the SMT protocol significantly improved the Oswestry Disability Index at 12 weeks (mean difference: -3.62, P = .01).
  • No other treatment components or their interactions showed significant effects on the primary or secondary outcome measures.
  • The optimized SMT protocol consisted of SMT sessions combined with multifidus activating exercises.

Conclusions:

  • The optimized SMT protocol for LBP involves combining SMT with lumbar multifidus strengthening exercises.
  • Multifidus activating exercises are a key component for enhancing patient-centered outcomes in SMT protocols for LBP.
  • Further research into optimizing nonpharmacological treatments is essential for managing complex conditions like LBP.