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Naprapathic Manual Therapy or Conventional Orthopedic Care for Outpatients on Orthopedic Waiting Lists?: A Pragmatic Randomized Controlled Trial

Lilje, Stina DN*; Friberg, Håkan MD*; Wykman, Anders PhD; Skillgate, Eva PhD‡ § ∥

doi: 10.1097/AJP.0b013e3181d71ebd
Original Articles

Objectives Traditionally, orthopedic outpatient waiting lists are long, and many referrals are for conditions that do not respond to interventions available at an orthopedic outpatient department. The overall objective of this trial was to investigate whether it is possible to reduce orthopedic waiting lists through integrative medicine. Specific aims were to compare the effects of naprapathic manual therapy to conventional orthopedic care for outpatients with nonurgent musculoskeletal disorders unlikely to benefit from surgery regarding pain, physical function, and perceived recovery.

Methods Seventy-eight patients referred to an orthopedic outpatient department in Sweden were included in this pragmatic randomized controlled trial. The 2 interventions compared were naprapathic manual therapy (index group) and conventional orthopedic care (control group). Pain, physical function, and perceived recovery were measured by questionnaires at baseline and after 12, 24, and 52 weeks. The number of patients being discharged from the waiting lists and the level of agreement concerning management decisions between the naprapath and the orthopedists were also estimated.

Results After 52 weeks, statistically significant differences between the groups were found regarding impairment in pain, increased physical function, and regarding perceived recovery, favoring the index group. Sixty-two percent of the patients in the index group agreed to be discharged from the waiting list. The level of agreement concerning the management decisions was 80%.

Discussion The trial suggests that naprapathic manual therapy may be an alternative to consider for orthopedic outpatients with disorders unlikely to benefit from surgery.

*Orthopedic Department, Blekingesjukhuset, Karlskrona

Orthopedic Department, Halmstad Lasarett, Halmstad

Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala

§Institute of Environmental Medicine, Karolinska Institutet

Skandinaviska Naprapathögskolan (Scandinavian College of Naprapathic Manual Medicine), Stockholm, Sweden

Financially supported by the Department for Primary Care and the Research and the Development Center at the county council of Blekinge, Karlskrona, Sweden, and the Swedish Naprapathic Association, Stockholm, Sweden.

Reprints: Stina Lilje, DN, Orthopedic Department, Blekingesjukhuset, SE-371 85, Karlskrona, Sweden (e-mail:

Received for publication May 7, 2009; revised December 10, 2009; accepted February 1, 2010

© 2010 Lippincott Williams & Wilkins, Inc.