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Low Back Pain: With Special Reference to Manual Therapy, Outcome and its Prognosis
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology. (Musculoskeletal disorders)
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives. To assess outcome of manual therapy in addition to stay-active care in sub-acute low back pain patients and to investigate the predictive power of pain drawing sketch variables for return to work.

Materials and methods. The study was designed as a randomised controlled trial with a factorial design, and included 160 patients with acute or sub-acute low back pain allocated to one of the four treatment groups during 10 weeks. Group 1 received stay-active care only, Group 2 the same treatment as in Group 1 + muscle stretching, Group 3 the same treatment as in Group 2 plus manual therapy, and Group 4 the same treatment as Group 3 plus steroid injections. Outcome included pain intensity, pain extension, functional and health related quality of life variables and return to work.

Results. Pain intensity and disability rating improved faster in Groups 3 and 4 than in Groups 1 and 2 (p<0.05 and p<0.05). Also health related quality of life was affected by the treatments given; the more treatment options the better the effect (trend across the groups p<0.05). Pain extension as described on a pain drawing sketch decreased in all groups across the study period. The pain modality ‘numbness’ was the most painful one among patients with no pain radiation. Pain radiation according to the pain drawing sketch was the strongest predictor for return to work (p=0.03, Wald χ2=4.56).

Conclusions. The manual therapy concept used in this study reduced pain intensity and disability rating better than the stay active concept. The effects on health related quality of life were greater the larger the number of treatment modalities available. Pain drawing information was significantly correlated with pain and functional variables. Pain radiation according to the pain drawing adds significant information to the prediction of return to work.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2011. , 79 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 691
Keyword [en]
Low Back Pain, Manual therapy, Stay active care, Mobilisation, Manipulation, Pain drawing, Return to work, Prognosis, Disability rating, Pain
National Category
Family Medicine
Research subject
Family Medicine
Identifiers
URN: urn:nbn:se:uu:diva-156739ISBN: 978-91-554-8122-3 (print)OAI: oai:DiVA.org:uu-156739DiVA: diva2:433520
Public defence
2011-09-30, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskölds väg 20, Uppsala Science Park, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2011-09-09 Created: 2011-08-08 Last updated: 2011-11-03Bibliographically approved
List of papers
1. The course of pain drawings during a 10-week treatment period in patients with acute and sub-acute low back pain
Open this publication in new window or tab >>The course of pain drawings during a 10-week treatment period in patients with acute and sub-acute low back pain
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2006 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 7, 65- p.Article in journal (Refereed) Published
Abstract [en]

Background: Pain drawings are widely used as an assessment of patients' subjective pain in lowback pain patients being considered for surgery. Less work has been done on primary health carepatients. Moreover, the possible correlation between pain drawing modalities and other painassessment methods, such as pain score and functional variables needs to be described. Thus, theobjectives were to describe the course of pain drawings during treatment in primary health carefor low back pain patients.Methods: 160 primary health care outpatients with acute or sub-acute low back pain were studiedduring 10 weeks of a stay active concept versus manual therapy in addition to the stay activeconcept. The patients filled out 3 pain drawings each, at baseline and after 5 and 10 weeks oftreatment. In addition the patients also reported pain and functional variables during the 3measurement periods.Results: The proportion of areas marked, the mean number of areas marked (pain drawing score),mean number of modalities used (area score), and the proportion of patients with pain radiationall decreased during the 10-week treatment period. Most of the improvement occurred during thefirst half of the period. The seven different pain modalities in the pain drawing were correlated topain and functional variables. In case of no radiation some modalities were associated with morepain and disability than others, a finding that grew stronger over time. For patients with painradiation, the modality differences were smaller and inconsistent.Conclusion: Pain modalities are significantly correlated with pain and functional variables. Thereis a shift from painful modalities to less painful ones over time.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-83627 (URN)10.1186/1471-2474-7-65 (DOI)000240737600001 ()16901354 (PubMedID)
Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2017-12-14Bibliographically approved
2. A randomized controlled clinical trial of stay-active care versus manual therapy in addition to stay-active care: functional variables and pain.
Open this publication in new window or tab >>A randomized controlled clinical trial of stay-active care versus manual therapy in addition to stay-active care: functional variables and pain.
2004 (English)In: Journal of Manipulative and Physiological Therapeutics, ISSN 0161-4754, E-ISSN 1532-6586, Vol. 27, no 7, 431-441 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES

To compare the effect of manual therapy in addition to the stay-active concept versus the stay-active concept only in low back pain patients.

STUDY DESIGN

A randomized, controlled trial during 10 weeks.

METHODS

One hundred sixty outpatients with acute or subacute low back pain were recruited from a geographically defined area. They were randomly allocated to a reference group treated with the stay-active concept and, in some cases, muscle stretching and an experimental group receiving manual therapy and, in some cases, steroid injections in addition to the stay-active concept. Pain and disability rating index were used as outcome measures.

RESULTS

At baseline, the experimental group had somewhat more pain, a higher disability rating index, and more herniated disks than the reference group. After 5 and 10 weeks, the experimental group had less pain and a lower disability rating index than the reference group.

CONCLUSIONS

The manual treatment concept used in this study in low back pain patients appears to reduce pain and disability rating better than the traditional stay-active concept.

Keyword
Low back pain, disability rating, manipulation, mobilization, stay-active care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-79639 (URN)10.1016/j.jmpt.2004.06.001 (DOI)000224327300001 ()15389174 (PubMedID)
Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2017-12-14Bibliographically approved
3. A randomized controlled trial of the effects of muscle stretching, manual therapy and steroid injections in addition to 'stay-active' care on health-related quality of life in acute and sub-acute low back pain
Open this publication in new window or tab >>A randomized controlled trial of the effects of muscle stretching, manual therapy and steroid injections in addition to 'stay-active' care on health-related quality of life in acute and sub-acute low back pain
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2011 (English)In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 25, no 11, 999-1010 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the health-related quality of life effects of muscle stretching, manual therapy and steroid injections in addition to 'stay active' care in acute or subacute low back pain patients.

Study design: A randomized, controlled trial during 10 weeks with four treatment groups.

Setting: Nine primary health care and one outpatient orthopaedic hospital department.

Subjects: One hundred and sixty patients with acute or subacute low back pain.

Interventions: Ten weeks of 'stay active' care only (group 1), or 'stay active' and muscle stretching (group 2), or 'stay active', muscle stretching and manual therapy (group 3), or 'stay active', muscle stretching, manual therapy and steroid injections (group 4).

Main measures: The Gothenburg Quality of Life instrument subscales Well-being score and Complaint score.

Results: In a multivariate analysis adjusted for possible outcome affecting variables other than the treatment given Well-being score was 68.4 (12.5), 72.1 (12.4), 72,3 (12.4) and 72.7 (12.5) in groups 1-4, respectively (P for trend <0.05). There were significant trends for the well-being components patience (P < 0.005), energy (P < 0.05), mood (P < 0.05) and family situation (P < 0.05). The remaining two components and Complaint score showed a non-significant trend towards improvement.

Conclusion: The effects on health-related quality of life were greater the larger the number of treatment modalities available. The 'stay active' treatment group, with the most restricted number of modalities, had the most modest health-related quality of life improvement, while group 4 with the most generous choice of treatment modalities, had the greatest improvement.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-156551 (URN)10.1177/0269215511403512 (DOI)000296747400005 ()21831926 (PubMedID)
Available from: 2011-08-08 Created: 2011-08-02 Last updated: 2017-12-08Bibliographically approved
4. The contribution of pain drawings in the prediction of return to work in patients with acute or sub-acute low back pain
Open this publication in new window or tab >>The contribution of pain drawings in the prediction of return to work in patients with acute or sub-acute low back pain
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Family Medicine
Identifiers
urn:nbn:se:uu:diva-156552 (URN)
Available from: 2011-08-08 Created: 2011-08-02 Last updated: 2011-11-03

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