Fondazione Don Carlo Gnocchi, Scientific Institute, Florence, Italy.
Clin Rehabil. 2010 Jan;24(1):26-36. doi: 10.1177/0269215509342328.
To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain.
Randomized trial, 12-month follow-up.
Outpatient rehabilitation department.
210 patients with chronic, non-specific low back pain, 140/210 women, age 59 +/- 14 years.
Back school and individual physiotherapy scheduled 15 1-hour-sessions for 3 weeks. Back school included: group exercise, education/ ergonomics; individual physiotherapy: exercise, passive mobilization and soft-tissue treatment. Spinal manipulation, given according to Manual Medicine, scheduled 4 to 6 20'-sessions once-a-week.
Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6) were assessed at baseline, discharge 3, 6, and 12 months.
205 patients completed the study. At discharge, disability score decreased by 3.7 +/- 4.1 for back school, 4.4 +/- 3.7 for individual physiotherapy, 6.7 +/- 3.9 for manipulation; pain score reduction was 0.9 +/- 1.1, 1.1 +/- 1.0, 1.0 +/- 1.1, respectively. At 12 months, disability score reduction was 4.2 +/- 4.8 for back school, 4.0 +/- 5.1 for individual physiotherapy, 5.9 +/- 4.6 for manipulation; pain score reduction was 0.7 +/- 1.2, 0.4 +/- 1.3, and 1.5 +/- 1.1, respectively. Spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups (P < 0.001); pain recurrences and drug intake were also reduced compared to back school (P < 0.05) or individual physiotherapy (P < 0.001).
Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.
比较脊柱推拿、背部学校和个体物理疗法治疗慢性下腰痛的效果。
随机试验，12 个月随访。
门诊康复科。
210 例慢性非特异性下腰痛患者，140/210 例为女性，年龄 59 ± 14 岁。
背部学校和个体物理疗法均安排 15 次 1 小时的课程，持续 3 周。背部学校包括：团体运动、教育/人体工程学；个体物理疗法：运动、被动运动和软组织治疗。脊柱推拿按照手法医学进行，每周一次，安排 4 至 6 次 20 分钟的课程。
在基线、3 个月、6 个月和 12 个月时，使用 Roland Morris 残疾问卷（评分 0-24）和疼痛评分量表（评分 0-6）进行评估。
205 例患者完成了研究。出院时，背部学校的残疾评分下降了 3.7 ± 4.1，个体物理疗法下降了 4.4 ± 3.7，脊柱推拿下降了 6.7 ± 3.9；疼痛评分的降低分别为 0.9 ± 1.1、1.1 ± 1.0、1.0 ± 1.1。12 个月时，背部学校的残疾评分下降了 4.2 ± 4.8，个体物理疗法下降了 4.0 ± 5.1，脊柱推拿下降了 5.9 ± 4.6；疼痛评分的降低分别为 0.7 ± 1.2、0.4 ± 1.3、1.5 ± 1.1。与背部学校或个体物理疗法相比，脊柱推拿治疗后的功能改善和长期疼痛缓解更为显著，但在随访中需要接受更多的进一步治疗（P < 0.001）；与背部学校（P < 0.05）或个体物理疗法（P < 0.001）相比，疼痛复发和药物摄入也有所减少。
与背部学校或个体物理疗法相比，脊柱推拿治疗可提供更好的短期和长期功能改善，以及更多的后续疼痛缓解。
