Universidade Federal do Rio Grande do Sul, Escola de Educação Física, Fisioterapia e Dança, Felizardo, 750 - LAPEX Building, Porto Alegre, RS, 90690-200, Brazil.
Instituto Brasileiro de Osteopatia, Porto Alegre, Brazil.
Chiropr Man Therap. 2020 Jun 3;28(1):25. doi: 10.1186/s12998-020-00316-7.
According to the American Physical Therapy Association, there is strong evidence to show that vertebral mobilization and manipulation procedures can be used to improve spinal and hip mobility and reduce pain and incapacity in low back pain patients that fit the clinical prediction rule.
To evaluate the immediate effects of high-velocity low-amplitude (HVLA) manipulation on pain and postural control parameters in individuals with nonspecific low back pain.
This study used a participant-blinded and assessor-blinded randomized controlled clinical trial involving a single session, in which 24 participants were randomly distributed into control (simulated manipulation) and intervention (HVLA lumbar manipulation) groups. The primary (pain: subjective pain intensity and pressure pain threshold) and secondary outcomes (postural control: ellipse area, center of pressure [COP] excursion, COP RMS velocity, and differences between the COP and center of projected gravity) were evaluated before and after the session using a numerical pain scale, algometer, and a force platform. For all outcomes, multiple mixed 2 (group) × 2 (time) ANOVAs were performed.
For the subjective pain intensity, only time was significant as a main effect, where pre-intervention presented a greater value then post-intervention (F [1.44] = 4.377; p = 0.042; r = 0.30). For the pressure pain threshold no significant effect was found. For the postural control parameters, as a main effect, only the ellipse area was significantly greater in the control group (F [1.44] = 6.760; p = 0.013; effect size = 0.36).
There was a reduction in subjective pain intensity, evaluated using a numerical scale, in both the intervention and control groups immediately after the intervention, suggesting that the spinal manipulation had a similar effect to the placebo procedure. No effect of HVLA lumbar manipulation was identified for postural control variables in either the intervention or control groups.
The study was registered at ClinicalTrials.gov under the number NCT02312778, registered at 14 September 2014.
根据美国物理治疗协会的说法，有强有力的证据表明，脊柱松动术和手法治疗可以改善脊柱和髋关节的活动度，并减轻符合临床预测规则的腰痛患者的疼痛和活动受限。
评估高速低幅（HVLA）手法对非特异性腰痛患者疼痛和姿势控制参数的即刻影响。
本研究采用参与者和评估者双盲的随机对照临床试验，单次治疗，24 名参与者随机分为对照组（模拟手法）和干预组（HVLA 腰椎手法）。使用数字疼痛量表、压力计和力平台评估主要（疼痛：主观疼痛强度和压痛阈值）和次要结局（姿势控制：椭圆面积、压力中心（COP）偏移、COP RMS 速度和 COP 与投影重力中心之间的差异）。对于所有结果，均进行了两次混合方差分析。
对于主观疼痛强度，只有时间是一个主要的影响因素，干预前的疼痛值大于干预后的疼痛值（F [1.44] = 4.377；p = 0.042；r = 0.30）。对于压痛阈值，没有发现显著的影响。对于姿势控制参数，作为一个主要的影响因素，只有对照组的椭圆面积显著增大（F [1.44] = 6.760；p = 0.013；效应大小= 0.36）。
干预组和对照组在干预后立即使用数字量表评估时，主观疼痛强度均有降低，这表明脊柱手法与安慰剂程序具有相似的效果。在干预组或对照组中，HVLA 腰椎手法对姿势控制变量均没有影响。
该研究在 ClinicalTrials.gov 上注册，编号为 NCT02312778，于 2014 年 9 月 14 日注册。
