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Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment 1

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Reprinted with permission from the British Medical Journal 300:1431-1437.1990. Objective - To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin.Design - Randomized controlled trial. Allocation to chiropractic or hospital management by minimization to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up to two years.Setting - Chiropractic and hospital outpatient clinics in 11 centers.Patients - 741 patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month.Interventions - Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilization or manipulation, or both.Main outcome measures - Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion.Results - Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7 percent points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow-up period. Secondary outcome measures also showed that chiropractic was more beneficial.Conclusions - For patients with low back pain in whom manipulation is not contraindicated, chiropractic almost certainly confers worthwhile, long-term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.J Orthop Sports Phys Ther 1991;13(6):278-287.
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... 9 Several studies have evaluated its safety 11,12 and efficacy for the treatment of musculoskeletal disorders, 11 in short-term [12][13][14][15][16][17] as well as long-term results. 18,19 These and other studies indicate that SMT is considered a safe and effective approach for the treatment of biomechanical musculoskeletal disorders. 12,[20][21][22][23][24][25][26] Different disciplines, such as chiropractic, 9,[27][28][29] physiotherapy, 30 osteopathy, 31 and orthopedics, 32 use SMT as a therapeutic option in their practices. ...
... 40 Corticospinal 41,42 excitability is usually increased, with some exceptions. 39 Increased muscle strength, 43,44 decreased muscle inhibition, 45 and muscle fatigue prevention were observed, 46 as were lower levels of proinflammatory cytokines 47 and pain sensation in humans 11,[13][14][15][16][17][18][19][48][49][50][51] and animals. 52,53 All these changes could interfere with sports performance, but there is still limited evidence to support SMT's ability to enhance sports performance. ...
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Objective: The purpose of this study was to review the literature regarding the relationship between spinal manipulative therapy (SMT) and sports performance. Methods: PubMed and Embase databases were searched for original studies published up to July 2016. Inclusion criteria were if SMT has been applied to athletes and if any sports performance-related outcome was measured. Results: Of the 581 potential studies, 7 clinical trials were selected. Most studies had adequate quality (≥6/11) when assessed by the PEDro scale. None of those studies assessed performance at an event or competition. Four studies revealed improvement in a sports performance test after SMT. Meta-analysis could not be performed because of the wide differences in methodologies, design, and outcomes measured. Spinal manipulative therapy influences a wide range of neurophysiological parameters that could be associated with sports performance. Of the 3 studies where SMT did not improve test performance, 2 used SMT not for therapeutic correction of a dysfunctional vertebral joint but to an arbitrary previously set joint. Conclusions: Although 4 of 7 studies showed that SMT improved sports performance tests, the evidence is still weak to support its use. Spinal manipulative therapy may be a promising approach for performance enhancement that should be investigated with more consistent methodologic designs.
... Many studies support spinal manipulation for acute LBP, resulting in both short-term benefits 7-10 and long-term benefits of 1 to 3 years. [11][12][13][14] Many systematic reviews discussed trials on efficacy of spinal manipulation; and other systematic reviews focused on harms related to spinal manipulation. [15][16][17][18] For acute low back pain, a higherquality Cochrane review found spinal manipulation to be slightly to moderately superior to sham manipulation for short-term pain relief during a meta-regression analysis. ...
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Introduction: We conducted an open label clinical to assess if beta 2 microglobulin (B2M) can be useful as prognostic factor that can increase the usefulness of International Prognostic Index (IPI)in patients with aggressive lymphoma ; with stage IV and high clinical risk. Methods: Between January 1999 to December 2015, 1388 patients with aggressive lymphoma ,in that were classified as high-clinical risk and stage IV, treated with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) or R-CHOP (CHOP+rituximab); B2M was adding to the staging procedures; they were classified in two groups: normal (< 3.0 mg/L) or elevated ( >3.0 mg/L) levels that were compared in response type and outcome. Results: Complete response, actuarial curves of progression-free survival and overall survival, were statistically better in patients with normal levels of B2M: 68%; 78% (95% Confidence interval(CI):(69% - 83%)) and 73%(95%CI: 67%-82 %) ; and 73% (95%CI:67%-81%) compared with patients with high levels were: 54%; 58%(95%CI; 48%-67%); and 47% (95%CI:39%-58%), (p <0.001) respectively. Multivariable analysis confirm that B2M and lactate dehydrogenase have powerful to detect a worse prognostic course. Conclusion: B2M appear to be a no-expensive, simple and reproducible marker to help defined an worse prognosis in patients with high clinical risk and advanced stage. Thus, will be considered to planned a clinical trial to test the efficacy of different chemotherapeutic regimens in these setting of patients.
... Several of the neurophysiological effects of SMT that have been demonstrated in studies could theoretically in uence sports performance. These include changes in surface electromyographic activity [18,19], corticospinal [20][21][22] and spinal cord [22][23][24] excitability, muscle strength [7,25,26], muscle inhibition [27,28], expression of proin ammatory cytokines [29], pain sensation [30][31][32][33][34][35][36][37][38], and prevention of muscle fatigue [39]. ...
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Background Asymptomatic spinal biomechanical alterations may generate impaired central nervous system proprioceptive input, and motor control, and central processing deficits, which could impair sports performance. Several of the demonstrated neurophysiological effects of spinal manipulative therapy (SMT) could theoretically influence sports performance. Further, some studies have demonstrated that SMT' may improve aspects of sports performance. These include improved full-swing in golfers, judoka grip strength, taekwondo muscle strength, and ball kicking speed in soccer. The purpose of this study was to assess the effect on the performance of elite athletes of one session of SMT to correct asymptomatic, biomechanical dysfunction, using professional soccer players and sprint and change of direction (COD) tests. Also, the proposed placebo intervention was tested for efficacy in achieving blinding. Methods A parallel-randomized, controlled, clinical trial was performed with 20 elite soccer players who were randomly assigned to one of two groups by a coin flip: one receiving SMT (n=10) and the other a placebo intervention (n=10). All players were from the same team, and were injury free and naive to SMT. Data were collected at the team training facility. Measured outcome tests (30-meter sprint run with a 10-meter split and COD test) were performed at the same time by all subjects immediately prior to and after interventions. Photocell devices were used for data acquisition. Participants and those assessing outcomes were blinded to group assignment. Care givers were not able to be blinded. Results 20 participants were analyzed, 10 in each group. There were no changes to the sprint (10m and 30m) and COD test results immediately following either of the interventions. All subjects (SMT and placebo) answered YES to a question after the intervention asking if they were treated by SMT. No adverse events were reported. Conclusion Spinal manipulative therapy to correct asymptomatic, biomechanical dysfunction in the spine and pelvis did not have any immediate effect on the performance of elite soccer players as measured by 10- and 30-meters sprint times and COD sprint times. Additionally, the proposed placebo strategy was successful in blinding these athletes. Trial registration ISRCTN29691307. Retrospectively registered in 07/02/2018. http://www.isrctn.com/ISRCTN29691307.
... It has been reported that the frequency of medical visits is greater when patients are receiving OMT as opposed to standard allopathic care. 21,22 An increase in medical visits could introduce its own placebo effect, but this is not relevant to this study as the number of visits were identical. Documenting medical costs, however, may provide additional evidence of the benefits associated with OMT. ...
Article
Context Osteopathic manipulative treatment (OMT) is a widely used methodology for the clinical treatment of spine-related pain. Recent reports have been especially positive regarding the use of OMT for chronic back pain. However, published reports have been focused on populations available within large university-based institutions, with rural-based hospitals and their clientele unrepresented within the professional literature Objective The objective of this multi-year study was to examine the effects of OMT on spine-related chronic pain and its effects on dimensions of functional ability in a rural setting served by a safety-net hospital. Methods In this study, 151 participants with chronic (>6 months) spine-related pain (mean age 54.58 ± 11.88 years) completed at least 2 office visits. The Oswestry Disability Index (ODI) was used to assess 10 dimensions (pain intensity, personal care, lifting, walking, sitting, sleeping, standing, sex life, social life, and travel) and a total score of functional ability related to back pain. Results A 2-way mixed-model, repeated-measures analysis of variance (ANOVA) with time (pre- and post-office visit) as the within-participants factor and with sex as the between-participants factor resulted in a significant main effect from pretest to posttest, (F(1,149) = 67.12, P < .001, η2p = .311), but not a significant interaction between time and gender, (F(1,149) = .426, P = .515, η2p = .003). Conclusions The results of this study support the hypothesis that OMT improved measures of functional ability related to pain intensity, unrelated to sex. The rural nature of the clinical setting provided a unique population for this study.
... Les manipulations permettent d'obtenir un soulagement symptomatique rapide des lombalgies aiguës non spécifiques [16][17][18] et des phénomènes secondaires (par ex. contractures musculaires), mais sans être, à vrai dire, franchement supérieures aux autres formes de traitement [19]. ...
... 44 Meade et al examined chiropractic care's effectiveness for CLBP, compared to hospital outpatient treatment. 45 Chiropractic treatment was more effective than hospital outpatient treatment for improving pain disability and flexibility tests of leg straightening and lumbar flexion in patients with CLBP. ...
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Pain and pain management are a growing concern among Americans age 65 and older.[1] A recent analysis of data from a National Institutes of Health (NIH)-funded study found that more than half (53%) of the older adults surveyed reported having bothersome pain in the last month; three-quarters of them reported having pain in more than 1 location. Bothersome pain, particularly in multiple locations, also was associated with decreased physical capacity. Full article found here: https://www.practicalpainmanagement.com/treatments/pain-management-elderly
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