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A Randomized Clinical Trial of Manipulative Therapy and Interferential Therapy for Acute Low Back Pain

Hurley, Deirdre A., BSc (Hons) MAppSc (Manip Ther) PhD, MISCP, MCSP*; McDonough, Suzanne M., BSc (Hons) PhD, MCSP; Dempster, Martin, BSc, PhD; Moore, Ann P., PhD, FCSP§; Baxter, G David, TD, BSc (Hons) DPhil, MCSP

doi: 10.1097/01.brs.0000142234.15437.da
Randomized Trial
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Study Design. A multicenter assessor-blinded randomized clinical trial was conducted.

Objectives. To investigate the difference in effectiveness of manipulative therapy and interferential therapy for patients with acute low back pain when used as sole treatments and in combination.

Summary of Background Data. Both manipulative therapy and interferential therapy are commonly used treatments for low back pain. Evidence for the effectiveness of manipulative therapy is available only for the short-term. There is limited evidence for interferential therapy, and no study has investigated the effectiveness of manipulative therapy combined with interferential therapy.

Methods. Consenting subjects (n = 240) recruited following referral by physicians to physiotherapy departments in the (government-funded) National Health Service in Northern Ireland were randomly assigned to receive a copy of the Back Book and either manipulative therapy (MT; n = 80), interferential therapy (IFT; n = 80), or a combination of manipulative therapy and interferential therapy (CT; n = 80). The primary outcome was a change in functional disability on the Roland Morris Disability Questionnaire. Follow-up questionnaires were posted at discharge and at 6 and 12 months.

Results. The groups were balanced at baseline for low back pain and demographic characteristics. At discharge all interventions significantly reduced functional disability (Roland Morris scale, MT: −4.53; 95% CI, −5.7 to −3.3 vs. IFT: −3.56; 95% CI, −4.8 to −2.4 vs. CT: −4.65; 95% CI, −5.8 to −3.5; P = 0.38) and pain (McGill questionnaire, MT: −5.12; 95% CI, −7.7 to −2.5 vs. IFT: −5.87; 95% CI, −8.5 to −3.3 vs. CT: −6.64; 95% CI, −9.2 to −4.1; P = 0.72) and increased quality of life (SF-36 Role-Physical, MT: 28.6; 95% CI, 18.3 to 38.9 vs. IFT: 31.4; 95% CI, 21.2 to 41.5 vs. CT: 30; 95% CI, 19.9 to 40; P = 0.93) to the same degree and maintained these improvements at 6 and 12 months. No significant differences were found between groups for reported LBP recurrence, work absenteeism, medication consumption, exercise participation, or healthcare use at 12 months (P > 0.05).

Conclusions. For acute low back pain, there was no difference between the effects of a combined manipulative therapy and interferential therapy package and either manipulative therapy or interferential therapy alone.

A randomized clinical trial investigated the difference in effectiveness of manipulative therapy and interferential therapy as sole and combination treatments for acute low back pain. At 12 months, all interventions had significantly reduced functional disability, pain, work absenteeism, and medication consumption and increased quality of life to the same extent.

From the *School of Physiotherapy, University College Dublin, Mater Misericordiae Hospital, Dublin, Republic of Ireland; †Reader in Rehabilitation Sciences, Rehabilitation Sciences Research Group, Faculty of Social and Health Sciences and Education, University of Ulster at Jordanstown, Antrim, Northern Ireland; ‡School of Psychology, Queen’s University, Belfast, Northern Ireland; §Department of Physiotherapy and Clinical, Research Unit for Healthcare Professions, University of Brighton, Eastbourne, England; and ¶Rehabilitation Sciences Research Group, Faculty of Social and Health Sciences and Education, University of Ulster at Jordanstown, Antrim, Northern Ireland.

Acknowledgment date: April 1, 2003. First revision date: July 18, 2003. Second revision date: October 28, 2003. Acceptance date: November 1, 2003.

Supported by the Society of Orthopaedic Medicine (UK and Republic of Ireland) Project Grants, Manipulation Association of Chartered Physiotherapists Churchill Livingstone Award and Research Presentation Award, and TensCare Ltd, London, for loan of interferential therapy Omega Inter 4150 portable units. This work was completed as part of a PhD thesis (D.A.H.) at the University of Ulster Rehabilitation Sciences Research Group.

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

Professional Organizational 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 Deirdre A. Hurley, PhD, School of Physiotherapy, University College Dublin, Mater Misericordiae Hospital, Eccles St, Dublin 7, Rep. Ireland; E-mail: deirdre.hurleyosing@ucd.ie

© 2004 Lippincott Williams & Wilkins, Inc.