Individualised manual therapy plus guideline-based advice vs advice alone for people with clinical features of lumbar zygapophyseal joint pain: a randomised controlled trial. Issue 1 (March 2019)

• Record Type: Journal Article
• Authors: Ford, Jon J.; Slater, Sarah L.; Richards, Matthew C.; Surkitt, Luke D.; Chan, Alexander Y.P.; Taylor, Nicholas F.; Hahne, Andrew J.
• Is Part Of: Physiotherapy. Volume 105:Issue 1(2019)
• Page Start: 53
• Page End: 64
• Publication Date: 2019-03
• Subjects: Back pain -- Manual therapy -- Spinal manipulative therapy -- Clinical trial -- Zygapophyseal joint -- Facet joint; Physical therapy -- Periodicals; Therapeutics, Physiological -- Periodicals; 615.8205
• DOI: 10.1016/j.physio.2018.07.008
• Languages: English
• ISSNs: 0031-9406

Abstract

Abstract: Objectives: To determine whether individualised manual therapy plus guideline-based advice results in superior outcomes to advice alone in participants with clinical features potentially indicative of lumbar zygapophyseal joint pain. Design: Multi centre parallel group randomised controlled trial. Setting: 14 physiotherapy clinics in Melbourne, Australia. Participants: Sixty-four participants with clinical features potentially indicative of lumbar zygapophyseal joint pain. Interventions: 10-weeks of physiotherapy comprising individualised manual therapy based on pathoanatomical, psychosocial and neurophysiological barriers to recovery plus guideline-based advice (10 sessions) or advice alone (two sessions). Main outcome measures: Primary outcomes were activity limitation (Oswestry Disability Index), and separate 0 to 10 numerical rating scales for leg pain and back pain. Measures were taken at baseline and 5, 10, 26 and 52-week. Results: Between-group differences for back pain favoured individualised manual therapy over advice for back pain at 5 (1.0; 95% CI 0.6 to 2.0), 10 (1.5; 95% CI 0.5 to 2.4) and 26-weeks (1.4; 95% CI 0.4 to 2.3) as well as for activity limitation at 26 (8.3; 95% CI 2.6 to 14.2) and 52-weeks (8.2; 95% CI 2.3 to 14.2). There were no significant between-group differences for leg pain. Secondary outcomes and responder analyses also favoured individualised manual therapy at almost all time-points. Conclusions: In participants with clinical features potentially indicative of lumbar zygapophyseal joint pain, individualised manual therapy led to greater reduction in back pain at 5, 10 and 26-week follow-up as well as activity limitation at 26 and 52-weeks. Between-group differences were likely to be clinically important. Trial registration: ACTRN12609000334202.