Restricted accessResearch articleFirst published online 2020-5
Osteopathic manipulation treatment versus therapeutic exercises in patients with chronic nonspecific low back pain: A randomized,controlled and double-blind study
Osteopathic manipulation treatment is widely used in the clinical practice in the care of patients with chronic nonspecific low back pain, however, its benefits still seem uncertain.
OBJECTIVE:
This study aimed to verify the efficacy of osteopathic manipulation for chronic nonspecific low back pain.
MATERIALS AND METHODS:
Forty-two participants with chronic nonspecific low back pain were selected and randomized into two groups: active control group (ACG – 19) and osteopathic manipulation treatment group (OMTG – 23). Therapeutic exercises were performed with the ACG and osteopathic manipulation techniques with the OMTG. The interventions were carried out over 5 weeks of treatment, totaling 10 treatments for the ACG and 5 for the OMTG.
The visual analogue scale (VAS) was used to measure chronic nonspecific low back pain and the Oswestry Disability Index 2.0, Tampa Scale of Kinesiophobia and Beck Depression Inventory were used to measure disability, kinesiophobia and depression, respectively.
RESULTS:
The final chronic nonspecific low back pain in both groups was significantly lower than the initial low back pain ( 0.01) and the final chronic nonspecific low back pain of the OMTG was significantly lower than that of the ACG ( 0.001).
CONCLUSION:
This study demonstrated that the treatments were effective in both groups. However, the efficacy of the osteopathic manipulation treatment was greater than that of the therapeutic exercises.
HaydenJAVan TulderMWMalmivaaraAVKoesBW. Meta-analysis: exercise therapy for nonspecific low back pain. Annals of Internal Medicine.2005; 142(9): 765. doi: 10.7326/0003-4819-142-9-200505030-00013.
2.
HaydenJAVan TulderMWTomlinsonG. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Annals of Internal Medicine.2005; 142(9): 776-85. (13). doi: 10.7326/0003-4819-142-9-200505030-00014.
3.
Van TulderMW. Exercise therapy for low back pain: a systematic review within the framework of the cochrane collaboration back review group. Spine.2000; 25(21): 2784-96. doi: 10.1097/00007632-200011010-00011.
4.
SmithBELittlewoodCMayS. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskeletal Disorders.2014; 15(1): 1. doi: 10.1186/1471-2474-15-416.
5.
MichelfelderAJLeeKCBadingEM. Integrative medicine and gastrointestinal disease. Primary Care: Clinics in Office Practice.2010; 37(2): 255-267. doi: 10.1016/j.pop.2010.02.003.
6.
SeffingerMABuserBRLicciardoneJC. American Osteopathic Association guidelines for osteopathic manipulative treatment (OMT) for patients with low back pain. Clinical Guideline Subcommittee on Low Back Pain (Nov). J Am Osteopath Assoc.2010; 110(11); 653-666.
7.
LicciardoneJCAngelaKBLindaNK. Osteopathic manipulative treatment for low back pain: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders.2005; 6(1): 43. doi: 10.1186/1471-2474-6-43.
8.
FrankeHFrankeJDFryerG. Osteopathic manipulative treatment for nonspecific low back pain: a systematic review and meta-analysis. BMC Musculoskeletal Disorders.2014; 15(1): 286. doi: 10.1186/1471-2474-15-286.
9.
MeirellesFOSilvaEB. A Eficácia da Osteopatia sobre a lombalgia: Uma revisão Sistemática. Revista Ter Man.2013; 11(51): 8.
10.
OrrockPJMyersSP. Osteopathic intervention in chronic non-specific low back pain: a systematic review. BMC Musculoskeletal Disorders.2013; 14(129). doi: 10.1186/1471-2474-14-129.
11.
SchulzKFAltmanDGMoherD. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Medicine.2010; 8(1): 18. doi: 10.1186/1741-7015-8-18.
12.
KoesBWVan TulderMWThomasS. Diagnosis and treastment of low back pain. BMJ: British Medical Journal.2006; 332: 7555-1430. doi: 10.1136/bmj.332.7555.1430.
13.
HelliwellM. Leg length inequality and low back pain. The Practitioner.1985; 229(1403): 483-5.
14.
RossvollIJunkSTerjesenT. The effect on low back pain of shortening osteotomy for leg length inequality. International Orthopaedics.1992; 16(4): 388-91. doi: 10.1007/bf00189625.
15.
BaeckeJABuremaJFrijtersJE. A short questionnaire for the measurement of habitual physical activity in epidemiological studies. Am J Clin Nutr.1982; 36: 936-942. doi: 10.1093/ajcn/36.5.936.
16.
FlorindoAALatorreMDR. Validação e reprodutibilidade do questionário de Baecke de avaliação da atividade física em homens adultos. Rev Bras Med.2003; 9: 121-128.
17.
FlorindoAALatorreMDRJaimePCTanakaTZerbiniCADF. Metodologia para a avaliação da atividade física habitual em homens com 50 anos ou mais. Revista de Saúde Pública.2004; 38: 307-314. doi: 10.1590/S0034-89102004000200022.
18.
AlmeidaBarrosMCRibeiroJLP. Adaptação do Habitual Physical Activity Questionnaire (Baecke), versão modificada, para a população portuguesa. Revista de Enfermagem Referência.2014; 3-27-36. doi: 10.12707/RIII1303.
19.
HaydenJACartwrightJvan TulderMWMalmivaara,A. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews.2012; (4). doi: 10.1002/146.
20.
MoffettJKTorgersonDBell-SyerSJacksonDLlewlyn-PhillipsHFarrinA, et al. Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences. BMJ.1999; 319(7205): 279-283. doi: 10.1136/bmj.319.7205.279.
21.
MannionAFMüntenerMTaimelaSDvorakJ. 1999 Volvo award winner in clinical studies: a randomized clinical trial of three active therapies for chronic low back pain. Spine.1999; 24(23): 2435. doi: 10.1097/00007632-199912010-00004.
22.
Van MiddelkoopMRubinsteinSMKuijpersTVerhagenAPOsteloRKoesBW, et al. A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain. European Spine Journal. 2011; 20(1): 19-39. doi: 10.1007/s00586-010-1518-3.
23.
AiraksinenOBroxJICedraschiCHildebrandtJKlaber-MoffettJKovacsF, et al. Chapter 4 European guidelines for the management of chronic nonspecific low back pain. European Spine Journal.2006; 15: s192-s300. doi: 10.1007/s00586-006-1072-1.
24.
KhalilTMAsfourSSMartinezLMWalySMRosomoffRSRosomoffHL. Stretching in the rehabilitation of low-back pain patients. Spine.1992; 17(3): 311-317. doi: 10.1097/00007632-199203000-00012.
25.
JohnsonShirleyMMargotE. Kurtz. Osteopathic manipulative treatment techniques preferred by contemporary osteopathic physicians. Journal American Osteopathic Association.2003; 103(5): 219-224.
26.
BronfortGHaasMEvansRKawchukGDagenaisS. Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. The Spine Journal.2008; 8(1): 213-225. doi: 10.1016/j.spinee.2007.10.023.
27.
BarnesMarkF. The basic science of myofascial release: morphologic change in connective tissue. Journal of Bodywork and Movement Therapies.1997; 1(4): 231-238. doi: 10.1016/ s1360-8592(97)80051-4
28.
MartínezMAZuriagaDSBeltránVLBlanchFGBeltránFPSantosRH, et al. Efectos de la manipulación lumbar y técnica de inducción miofascial toracolumbar sobre el patrón de activación del erector espinal. Fisioterapia.2010; 32(6): 250-255. doi: 10.1016/j.ft.2010.07.003.
29.
ScopelEAlencarMCruzRM. Medidas de avaliação da dor. Lecturas: Educación Física y Deportes.2007; (105), 34.
30.
HuskissonEC. Visual analogue scales. Pain Measurement and Assessment.1983; 33-37.
31.
BoonstraAMPreuperHRSRenemanMFPosthumusJBStewartRE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. International Journal of Rehabilitation Research.2008; 31(2): 165-169. doi: 10.1097/MRR.0b013e3282fc0f93.
32.
BijurPEWendySJohnG. Reliability of the visual analog scale for measurement of acute pain. Academic Emergency Medicine.2001; 8(12): 1153-1157.
33.
Ferreira-ValenteMAPais-RibeiroJLJensenMP. Validity of four pain intensity rating scales. Pain®.2011; 152(10): 2399-2404. doi: 10.1016/j.pain.2011.07.005.
34.
PriceDDMcGrathPARafiiABuckinghamB. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain.1983; 17(1): 45-56. doi: 10.1016/0304-3959(83)90126-4.
35.
FairbankJeremyCTPaulBP. The Oswestry disability index. Spine.2000; 25(22): 2940-2953. doi: 10.1097/00007632-200011150-00017.
36.
Roland, MartinJeremyF. The Roland-Morris disability questionnaire and the Oswestry disability questionnaire. Spine.2000; 25(24): 3115-3124. doi: 10.1097/00007632-200012150-00006.
37.
Davidson, MeganJenniferLK. A comparison of five low back disability questionnaires: reliability and responsiveness. Physical therapy;2002; 82(1): 8-24. doi: 10.1093/ptj/82.1.8.
38.
VigattoRNeusaMCAHelenoRCF. Development of a Brazilian Portuguese version of the Oswestry Disability Index: cross-cultural adaptation, reliability, and validity. Spine.2007; 32(4): 481-486. doi: 10.1097/01.brs.0000255075.11496.47.
39.
SiqueiraFBLuciF, Teixeira-SalmelaMagalhãesLC. Adaptação transcultural da Tampa Scale for Kinesiophobia em indivíduos com dor lombar crônica. Brazilian Journal of Physical Therapy. 2006; 10. Suplemento 2: 96-97.
40.
SiqueiraFBLuciF, Teixeira-SalmelaMagalhãesLC. Análise das propriedades psicométricas da versão brasileira da escala tampa de cinesiofobia. Acta Ortop Bras.2007; 15(1): 19-24. doi: 10.1590/S1413-78522007000100004.
41.
de SouzaFSda Silva MarinhoCSiqueira,FBMaherCGCostaLOP. Psychometric testing confirms that the Brazilian-Portuguese adaptations, the original versions of the Fear-Avoidance Beliefs Questionnaire, and the Tampa Scale of Kinesiophobia have similar measurement properties. Spine.2008; 33(9): 1028-1033. doi: 10.1097/BRS.0b013e31816c8329.
42.
Swinkels-MeewisseEJCMSwinkelsRAHMVerbeekALMVlaeyenJWSOostendorpRAB. Psychometric properties of the Tampa Scale for kinesiophobia and the fear-avoidance beliefs questionnaire in acute low back pain. Manual Therapy.2003; 8(1): 29-36. doi: 10.1054/math.2002.0484.
43.
MillerRPShashidarHKDennisDT. The Tampa Scale: A Measure of Kinesiophobia. The Clinical Journal of Pain.1991; 7(1): 51.
44.
BeckATWardCMendelsonM. Beck depression inventory (BDI). Arch Gen Psychiatry.1961; 4(6): 561-71.
45.
BeckATRobertASMargeryG. Carbin. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review.1988; 8(1): 77-100. doi: 10.1016/0272-7358(88)90050-5.
46.
Gorenstein,CAndradeLH. Inventário de depressão de Beck: propriedades psicométricas da versão em português. Rev psiquiatr Clín.1998; 25(5): 245-50.
47.
GorensteinCAndradeLH. Validation of a Portuguese version of the Beck Depression Inventory and the State-Trait Anxiety Inventory in Brazilian subjects. Brazilian Journal of Medical and Biological Research.1996; 29(4): 453-7.
48.
CohenJ. Statistical power analysis for the behavior science. Lawrance Eribaum Association.1988.
49.
OsteloRWDeyoRAStratfordPWaddellGCroftPVon KorffM, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine.2008; 33(1): 90-94. doi: 10.1097/BRS.0b013e31815e3a10.
50.
LicciardoneJCKearnsCMMinottiDE. Outcomes of osteopathic manual treatment for chronic low back pain according to baseline pain severity: results from the OSTEOPATHIC Trial. Manual Therapy.2013; 18(6): 533-40. doi: 10.1016/j.math.2013.05.006.
51.
MandaraAFusaroAMusiccoMBadoF. A randomised controlled trial on the effectiveness of osteopathic manipulative treatment of chronic low back pain. International Journal of Osteopathic Medicine.2008; 11(4): 156. doi: 10.1016/j.ijosm.2008.08.011.
52.
VismaraLCimolinVMenegoniFZainaFGalliMNegriniS, et al. Osteopathic manipulative treatment in obese patients with chronic low back pain: a pilot study. Manual Therapy.2012; 17(5): 451-455. doi: 10.1016/j.math.2012.05.002.
53.
HodgesPWTsaoHSimsK. Gain of postural responses increases in response to real and anticipated pain. Experimental Brain Research.2015; 233(9): 2745-52. doi: 10.1007/s00221-015-4347-0.
54.
WinbyCRLloydDGBesierTFKirkTB. Muscle and external load contribution to knee joint contact loads during normal gait. Journal of Biomechanics.2009; 42(14): 2294-2300. doi: 10.1016/j.jbiomech.2009.06.019.
55.
MarrasWSDavisKGFergusonSALucasBRGuptaP. Spine loading characteristics of patients with low back pain compared with asymptomatic individuals. Spine.2001; 26(23): 2566-2574. doi: 10.1097/00007632-200112010-00009.
56.
ReevesNPEverdingVQCholewickiJMorrisetteDC. The effects of trunk stiffness on postural control during unstable seated balance. Experimental Brain Research.2006; 174(4): 694. doi: 10.1007/s00221-006-0516-5.
57.
MokNWBrauerSGHodgesPW. Changes in lumbar movement in people with low back pain are related to compromised balance. Spine.2011; 36(1): E45-52. doi: 10.1097/BRS.0b013e3181dfce83.
58.
CholewickiJSilfiesSPShahRAGreeneHSReevesNPAlviK, et al. Delayed trunk muscle reflex responses increase the risk of low back injuries. Spine.2005; 30(23): 2614-2620. doi: 10.1097/01.brs.0000188273.27463.bc.
59.
LeeuwMHoubenRMSevereijnsRPicavetHSJSchoutenEGVlaeyenJW. Pain-related fear in low back pain: A prospective study in the general population. European Journal of Pain.2007; 11(3): 256-266. doi: 10.1016/j.ejpain.2006.02.009.
60.
BoersmaKLintonSJ. Psychological processes underlying the development of a chronic pain problem: a prospective study of the relationship between profiles of psychological variables in the fear-avoidance model and disability. The Clinical Journal of Pain.2006; 22(2): 160-6. doi: 10.1097/01.ajp.0000159582.37750.39.
61.
JarvikJGHollingworthWHeagertyPJHaynorDRBoykoEJDeyoRA. Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors. Spine.2005; 30(13): 1541-1548. doi: 10.1097/01.brs.0000167536.60002.87.
62.
RushAJPolatinPGatchelRJ. Depression and chronic low back pain: establishing priorities in treatment. Spine.2000; 25(20): 2566-71. doi: 10.1097/00007632-200010150-00004.
63.
HurwitzELMorgensternHYuF. Cross-sectional and longitudinal associations of low-back pain and related disability with psychological distress among patients enrolled in the UCLA Low-Back Pain Study. Journal of Clinical Epidemiology.2003; 56(5): 463-71. doi: 10.1016/S0895-4356(03)00010-6.
64.
O’SullivanP. It’s time for change with the management of non-specific chronic low back pain. British Journal of Sports Medicine.2012; 46(4): 224-7. doi: 10.1136/bjsm.2010.081638.
65.
NgLCañeiroJPCampbellASmithABurnettAO’SullivanP. Cognitive functional approach to manage low back pain in male adolescent rowers: a randomised controlled trial. Br J Sports Med.2015; 49(17): 1125-1131. doi: 10.1136/bjsports-2014-093984.
66.
KarjalainenKMalmivaaraAvan TulderMRoineRJauhiainenMHurriH, et al. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain in working-age adults: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine.2001; 26(3): 262-269. doi: 10.1097/00007632-200102010-00011.
67.
LicciardoneJCHerronKM. Characteristics, satisfaction, and perceptions of patients receiving ambulatory healthcare from osteopathic physicians: a comparative national survey. The Journal of the American Osteopathic Association.2001; 101(7): 374-385.
68.
LicciardoneJGamberRCardarelliKA. Patient satisfaction and clinical outcomes associated with osteopathic manipulative treatment. The Journal of the American Osteopathic Association.2002; 102(1): 13-20.
69.
PincusTVogelSSavageRNewmanS. Patients’ satisfaction with osteopathic and GP management of low back pain in the same surgery. Complementary Therapies in Medicine.2000; 8(3): 180-186. doi: 10.1054/ctim.2000.0378.
70.
DeyoRAMirzaSKTurnerJAMartinBI. Overtreating chronic back pain: time to back off? J Am Board Fam Med.2009; 22(1): 62-68. doi: 10.3122/jabfm.2009.01.080102.
