Comparative Effectiveness of Dextrose Prolotherapy Versus Physiotherapy in Chronic Nonspecific Low Back Pain: A Retrospective Comparative Study

Abstract

Background

Chronic nonspecific low back pain (CLBP) is a leading cause of disability worldwide and is commonly managed using non-pharmacological and integrative approaches.

Objective

This study aimed to compare short-term clinical outcomes of a structured physiotherapy program incorporating electrotherapeutic modalities with 5% dextrose prolotherapy in adults with CLBP.

Methods

Medical records of adults treated between June and August 2023 were retrospectively reviewed. Patients received either a 2-week physiotherapy program (n = 30) or dextrose prolotherapy (n = 25). Pain intensity [visual analog scale (VAS)], functional disability [Oswestry disability index (ODI)], and health-related quality of life (NHP) were assessed at baseline and week 2 in both groups; additional week-4 data were available for the prolotherapy group. Between-group comparisons were performed using Mann–Whitney U tests, and within-group changes were analyzed using Wilcoxon signed-rank tests. ANCOVA models adjusted week-2 outcomes for corresponding baseline values.

Results

Both groups showed significant improvements from baseline to week 2 in VAS, ODI, and NHP (all p < 0.001), with large within-group effect sizes (r ≥ 0.80). Baseline ODI was higher in the physiotherapy group (p = 0.003) and was a strong independent predictor of week-2 ODI (F(1,52) = 19.84, p < 0.001). No significant between-group difference was found for week-2 VAS (p = 0.784). In contrast, unadjusted week-2 ODI differed between groups (p < 0.001); however, this difference was not significant after baseline adjustment (F(1,52) = 3.34, p = 0.074). In the prolotherapy group, continued improvement was observed at week 4.

Conclusions

Both interventions were associated with significant short-term clinical improvement. After baseline adjustment, no statistically significant between-group differences were observed. At week 2, prolotherapy following a single injection yielded short-term improvements comparable in magnitude to those observed after completion of an intensive physiotherapy program. However, given the temporal asymmetry of treatment exposure at week 2, these findings should be interpreted as short-term comparative response patterns rather than definitive conclusions regarding comparative effectiveness. Prospective, adequately powered randomized studies with aligned treatment timelines are required to clarify comparative effectiveness.