Orthopedic Manual Physical Therapy May Not Enhance Biobehavioral Therapy in Chronic Low Back Pain

Orthopedic manual physical therapy, when combined with biobehavioral therapy, may not provide additional benefits to patients with chronic low back pain, according to a study published in Pain Medicine.

In this single-blind randomized controlled trial, a total of 50 patients with nonspecific chronic low back pain were randomly assigned to receive biobehavioral therapy alone or in combination with orthopedic manual physical therapy biweekly for 4 weeks. At baseline, participants asked to complete a questionnaire to gather sociodemographic data, to provide self-reported measures, and were given a physical examination that included lumbar spine assessment. The physical examination and self-reports were repeated at the end of the intervention and at the 3-month follow-up. Primary outcome measures included pain intensity evaluated with a visual analog scale, frequency of pain (ie, number of days with pain in the last month), and medication intake and frequency in the last month. Pain intensity was found to vary with time (P <.001), but not with time-by-group interactions (P =.581). Pain frequency was found to vary for time (P <.001), but not for time-by group interaction (P =.14). In both groups, medication intake was lower at the 3-month follow-up compared with baseline, with no between-group difference (reduction: control, 18.2%; experimental, 23.1%; P >.05). The frequency of medication intake decreased over time (P <.001), but not between groups (P =.755).

Study limitations include intergroup pretreatment differences in kinesiophobia.

“[T]here are no statistically significant differences in the comparison of the 2 treatments applied in patients with nonspecific [chronic low back pain]. In the individual analysis of each intervention, the results show that in the short term and medium term, there was a decrease in the intensity and frequency of pain and an improvement in physical, somatosensory, and psychological variables. According to our results, we can conclude that orthopedic manual physical therapy does not increase the effects of physiotherapy treatment based on biobehavioral therapy,” concluded the study authors.

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Reference

Grande-Alonso M, Suso-Martí L, Cuenca-Martínez F, Pardo-Montero J, Gil-Martínez A, La Touche R. Physiotherapy based on a biobehavioral approach with or without orthopedic manual physical therapy in the treatment of nonspecific chronic low back pain: a randomized controlled trial [published online May 7, 2019]. Pain Med. doi: 10.1093/pm/pnz093