Effect of high-velocity low amplitude thrust spinal manipulation alters segmental instability, pain intensity, and health-related quality of life among patients with chronic non-specific low back pain: A randomized control trial.

Prof. (Dr.) Jasobanta Sethi, MPT, PhD, FIAP Amity Institute of Physiotherapy, Amity University, UP, Noida-201313, India  

Abstract:
Background: Chronic non-specific low back pain (NSCLBP) is the single largest, common, complex musculoskeletal condition in the world and it’s estimated that 80% of the population have experienced almost in every adult individual’s life. The purpose of this study was to investigate the effectiveness of spinal manipulation therapy- high-velocity low amplitude thrust (SMT-HVLA thrust) changes in pain intensity and segmental instability and quality of life in patients with CNSLBP.

Materials and Methods:
Randomized controlled trial conducted on 105 patients with CNSLBP (with duration of pain more than 3 months) distributed in three groups with 35 participants in each group and an average age of the participants was 25.66 (SD=6.74) years. Participants receiving the SMT-HVLA thrust with ergonomic advice (Study Group-1), core stability exercise with ergonomic advice (Study Group-2), and supervised exercise with ergonomic advice (Control Group) were assigned in three groups for intervention for 4 weeks. Primary outcomes were pain intensity measured by a 0 to 10 numeric pain rating scale and postural sway (center of foot pressure) measured by Win track Platform and quality of life measured by EuroQoL questionnaire at 2 weeks and 4 weeks. Univariate analysis of variance (ANOVA) with post-hoc Tukey's multiple comparison tests was carried out to examine treatment effects and the relationship between groups changes across outcome measures.

Results:
For all three treatment groups, outcomes checked after 2 weeks of treatment. Those who received spinal manipulation therapy with ergonomic advice had slightly better outcomes than the supervised exercise and advice group at 2 weeks (between-group difference, pain intensity (P=0.001), segmental instability (P=0.001) and quality of life (P=0.001) as compared to core stability exercise with ergonomic advice and supervised exercise and ergonomic advice group at 2 weeks (between-group difference, pain intensity (P=0.03), segmental instability (P=0.04) and quality of life (P=0.05) as well as at 4 weeks (between-group difference) in pain intensity (P=0.05), segmental instability (P=0.03), quality of life (P=0.04).

Results:
For all three treatment groups, outcomes checked after 2 weeks of treatment. Those who received spinal manipulation therapy with ergonomic advice had slightly better outcomes than the supervised exercise and advice group at 2 weeks (between-group difference, pain intensity (P=0.001), segmental instability (P=0.001) and quality of life (P=0.001) as compared to core stability exercise with ergonomic advice and supervised exercise and ergonomic advice group at 2 weeks (between-group difference, pain intensity (P=0.03), segmental instability (P=0.04) and quality of life (P=0.05) as well as at 4 weeks (between-group difference) in pain intensity (P=0.05), segmental instability (P=0.03), quality of life (P=0.04).

Keywords: High-velocity low amplitude thrust, core stability exercise, supervises exercise.