Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
Neuromusculoskeletal Research Group, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada.
BMC Musculoskelet Disord. 2019 Jan 18;20(1):29. doi: 10.1186/s12891-019-2408-4.
Spinal manipulative therapy (SMT) includes biomechanical parameters that vary between clinicians, but for which the influence on the therapy clinical effects is unknown. This parallel-randomized controlled trial aimed to investigate the effect of SMT biomechanical parameters on the outcomes of participants with chronic thoracic pain (CTP) following three treatment sessions (follow-up at one week).
Adults reporting CTP (pain within the evaluated region [T6 to T8] for ≥3 months) were asked to participate in a four-session trial. At the first session, participants were randomly assigned to one of three experimental groups (different SMT doses) or the control group (no SMT). During the first three sessions, one SMT was executed at T7 for the experimental groups, while a 5-min rest was provided to the control group. SMT were delivered through an apparatus using a servo-controlled linear actuator motor and doses consisted of peak forces, impulse durations, and rates of force application set at 135 N, 125 ms and 920 N/s (group 1), at 250 N, 125 ms and 1840 N/s (group 2), and at 250 N, 250 ms, 920 N/s (group 3). Disability and pain intensity were evaluated at each session (primary outcomes). Spinal stiffness was assessed before-and-after each SMT/rest and at follow-up. Tenderness and muscle activity were evaluated during each spinal stiffness trial. Improvement was evaluated at follow-up. Differences in outcomes between groups and sessions were evaluated as well as factors associated with clinical improvement.
Eighty-one participants were recruited and 17, 20, 20 participants of the three experimental groups and 18 of the control group completed the protocol. In exception of higher pain intensity at baseline in the control group, no between-group differences were found for any of the outcomes. A decrease in pain intensity, disability, spinal stiffness, and tenderness during spinal stiffness were observed (p-values< 0.05). At follow-up, 24% of participants were classified as 'improved'. Predictors of improvement were a greater decrease in pain intensity and in tenderness (p-values< 0.05).
In an experimental setting, the delivery of a SMT does not lead to significantly different outcomes in participants with CTP than a control condition (spinal stiffness assessment). Studies are still required to explore the mechanisms underlying SMT effects.
ClinicalTrials.gov NCT03063177 , registered 24 February 2017).
脊柱手法治疗（SMT）包括临床医生之间变化的生物力学参数，但这些参数对治疗临床效果的影响尚不清楚。这项平行随机对照试验旨在研究 SMT 生物力学参数对慢性胸背痛（CTP）患者三次治疗后（一周后随访）结局的影响。
报告有 CTP（在评估区域[T6 至 T8]内疼痛持续≥3 个月）的成年人被邀请参加为期四节的试验。在第一次就诊时，参与者被随机分配到三个实验组（不同的 SMT 剂量）或对照组（无 SMT）之一。在前三节中，实验组在 T7 处执行一次 SMT，而对照组则提供 5 分钟的休息时间。SMT 通过使用伺服控制线性执行器电机的设备进行，剂量包括峰值力、脉冲持续时间和力施加率，设定为 135N、125ms 和 920N/s（第 1 组）、250N、125ms 和 1840N/s（第 2 组）和 250N、250ms、920N/s（第 3 组）。在每次就诊时评估残疾和疼痛强度（主要结局）。在每次 SMT/休息前后以及随访时评估脊柱刚度。在每次脊柱刚度试验期间评估压痛和肌肉活动。在随访时评估改善情况。评估组间和节间的结果差异以及与临床改善相关的因素。
共招募了 81 名参与者，其中三个实验组的 17、20、20 名参与者和对照组的 18 名参与者完成了方案。除对照组基线时疼痛强度较高外，各组之间在任何结果上均无差异。在脊柱刚度试验中观察到疼痛强度、残疾、脊柱刚度和压痛的降低（p 值<0.05）。在随访时，24%的参与者被归类为“改善”。改善的预测因素是疼痛强度和压痛的更大降低（p 值<0.05）。
在实验环境中，与对照组（脊柱刚度评估）相比，SMT 对 CTP 患者的治疗结果没有显著差异。仍需要研究来探索 SMT 效应的机制。
ClinicalTrials.gov NCT03063177，注册于 2017 年 2 月 24 日。
