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Manual Therapy and Exercise Therapy in Patients With Chronic Low Back Pain: A Randomized, Controlled Trial With 1-Year Follow-up

Aure, Olav Frode, PT; Hoel Nilsen, Jens, PT; Vasseljen, Ottar, PhD

doi: 10.1097/01.BRS.0000049921.04200.A6
Randomized Trial

Study Design. A multicenter, randomized, controlled trial with 1-year follow-up.

Objectives. To compare the effect of manual therapy to exercise therapy in sick-listed patients with chronic low back pain (>8 wks).

Summary and Background Data. The effect of exercise therapy and manual therapy on chronic low back pain with respect to pain, function, and sick leave have been investigated in a number of studies. The results are, however, conflicting.

Methods. Patients with chronic low back pain or radicular pain sick-listed for more than 8 weeks and less than 6 months were included. A total of 49 patients were randomized to either manual therapy (n = 27) or to exercise therapy (n = 22). Sixteen treatments were given over the course of 2 months. Pain intensity, functional disability (Oswestry disability index), general health (Dartmouth COOP function charts), and return to work were recorded before, immediately after, at 4 weeks, 6 months, and 12 months after the treatment period. Spinal range of motion (Schober test) was measured before and immediately after the treatment period only.

Results. Although significant improvements were observed in both groups, the manual therapy group showed significantly larger improvements than the exercise therapy group on all outcome variables throughout the entire experimental period. Immediately after the 2-month treatment period, 67% in the manual therapy and 27% in the exercise therapy group had returned to work (P < 0.01), a relative difference that was maintained throughout the follow-up period.

Conclusions. Improvements were found in both intervention groups, but manual therapy showed significantly greater improvement than exercise therapy in patients with chronic low back pain. The effects were reflected on all outcome measures, both on short and long-term follow-up.

From *Larvik Fysioterapi

and †Hovland Fysioterapi, Larvik,

and the ‡Faculty of Medicine, Department of Community Medicine and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.

The study was funded by the Foundation for Education and Research In Physiotherapy, Norway.

Acknowledgment date: April 12, 2001.

First revision date: July 23, 2001. Second revision date: December 17, 2001.

Acceptance date: August 22, 2002.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Professional Organization funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Olav Frode Aure, PT, Larvik Fysioterapi, Kongegaten 16, Larvik 3256, Norway; E-mail:

Copyright © 2003 Wolters Kluwer Health, Inc. All rights reserved.