Department of Physical Therapy, Franklin Pierce University, Concord, NH03301, USA.
Spine (Phila Pa 1976). 2009 Dec 1;34(25):2720-9. doi: 10.1097/BRS.0b013e3181b48809.
Randomized clinical trial.
The purpose of this randomized clinical trial was to examine the generalizability of 3 different manual therapy techniques in a patient population with low back pain that satisfy a clinical prediction rule (CPR).
Recently a CPR that identifies patients with LBP who are likely to respond rapidly and dramatically to thrust manipulation has been developed and validated. The generalizability of the CPR requires further investigation.
A total of 112 patients were enrolled in the trial and provided demographic information and completed a number of self-report questionnaires including the Oswestry Disability Questionnaire (ODQ) and the Numerical Pain Rating Scale (NPRS) at baseline, 1-week, 4-weeks, and 6-months. Patients were randomly assigned to receive 1 of the 3 manual therapy techniques for 2 consecutive treatment sessions followed by exercise regimen for an additional 3 sessions. We examined the primary aim using a linear mixed model for repeated measures, using the ODQ and NPRS as dependent variables. The hypothesis of interest was the group by time interaction, which was further explored with pair-wise comparisons of the estimated marginal means.
There was a significant group x time interaction for the ODQ (P < 0.001) and NPRS scores (P = 0.001). Pair-wise comparisons revealed no differences between the supine thrust manipulation and side-lying thrust manipulation at any follow-up period. Significant differences in the ODQ and NPRS existed at each follow-up between the thrust manipulation and the nonthrust manipulation groups at 1-week and 4-weeks. There was also a significant difference in ODQ scores at 6-months in favor of the thrust groups.
The results of the study support the generalizability of the CPR to another thrust manipulation technique, but not to the nonthrust manipulation technique that was used in this study. In general, our results also provided support that the CPR can be generalized to different settings from which it was derived and validated. However, additional research is needed to examine this issue.
随机临床试验。
本随机临床试验的目的是在满足临床预测规则（CPR）的腰痛患者人群中，检验 3 种不同手动治疗技术的普遍性。
最近开发并验证了一种 CPR，可识别出对推力手法治疗迅速和显著反应的腰痛患者。CPR 的普遍性需要进一步研究。
共有 112 名患者参加了试验，并提供了人口统计学信息，并在基线、1 周、4 周和 6 个月时完成了多项自我报告问卷，包括 Oswestry 残疾问卷（ODQ）和数字疼痛评分量表（NPRS）。患者被随机分配接受 3 种手动治疗技术中的 1 种，连续治疗 2 次，然后再进行 3 次运动治疗。我们使用重复测量的线性混合模型检查主要目标，将 ODQ 和 NPRS 作为因变量。感兴趣的假设是组间时间交互作用，进一步通过估计边缘均值的两两比较进行探讨。
ODQ（P<0.001）和 NPRS 评分（P=0.001）的组间时间交互作用具有统计学意义。两两比较显示，在任何随访期间，仰卧位推力手法和侧卧位推力手法之间没有差异。在 1 周和 4 周时，推力手法组和非推力手法组之间在 ODQ 和 NPRS 上存在显著差异。在 6 个月时，推力组的 ODQ 评分也存在显著差异。
该研究结果支持 CPR 可推广应用于另一种推力手法，但不能推广应用于本研究中使用的非推力手法。总体而言，我们的结果还支持 CPR 可以推广应用于与其来源和验证不同的环境。然而，需要进一步的研究来检验这个问题。
