Manual therapy with steroid injections in low-back pain. Improvement of quality of life in a controlled trial with four months' follow-up.

OBJECTIVE

To compare prospectively the effect of manual treatment such as manipulation, specific mobilization, muscle stretching, auto-traction, and cortisone injections with standardized conventional but optimized activating treatment by primary health care teams.

DESIGN

Prospective controlled multicentre trial with four months' follow-up.

SETTING

Kopparberg County, Sweden. Six primary health care or occupational health care centres, representing a catchment area of 56000 residents participated.

PARTICIPANTS

101 outpatients with acute or subacute low-back pain were, during the period February 1988 to April 1989, randomly allocated to one of two treatment groups.

MAIN OUTCOME MEASURE

Quality of life was assessed at baseline and at four months by means of visual analogue scales (VAS). The occurrence of 27 different symptoms of a psychosomatic character was surveyed initially and at four months by questions answered by "yes" or "no" in a questionnaire.

RESULTS

There were significant differences concerning quality of life and presence of general symptoms in favour of the group receiving manual treatment with steroid injections.

CONCLUSION

Manual treatment with steroid injections was superior to conventional treatment in minimizing mental and somatic symptoms and increasing quality of life, in parallel with other measures of improvement.