Date of Award

5-2009

Degree Type

Dissertation

Degree Name

Doctor in Public Health

Field of Study

Biostatistics

Department

School of Public Health

First Advisor

Dr. Karan Singh

Abstract

Low back pain (LBP) can interfere with an individual’s ability to work, have a meaningful and active social life, and negatively affects overall quality of life. In recent years, new approaches have been considered as alternative treatments for LBP. Spinal manipulative therapy (SMT) is one of these new approaches to acute LBP treatment. Still, recent studies have found contradicting results in terms of the effectiveness of such alternative therapies. This study aimed to compare the effect of SMT in combination with standard physical therapy (SPT) versus SPT alone to treat chronic LBP. A randomized, controlled, parallel-group trial was undertaken in the Worker’s Compensation System, in Puerto Rico. A total of 66 subjects were enrolled in the study. The intervention consisted of adding two consecutive SMT two days apart followed by SPT for a total period of one month. The main outcome measures were functional impairment in activities of daily living, disability and perceived level of pain intensity and frequency. Results showed that both interventions were moderately effective in managing pain and disability in patients with chronic LBP who participate in the Worker’s Compensation Program, but that the addition of a SMT seemed to add minimal supplemental benefit to standard treatment. Future studies should consider including subjective and objective outcome measures in order to maximize information and understand the psychological, as well as, the physical effect LBP has on functional activities. It is also recommended to take into consideration diagnosed and undiagnosed depression among participants as it might have a negative effect on treatment outcomes. Finally, considering a moderate to severe level of impairment and disability at baseline might be important in order to avoid a floor effect and detect improvement with treatment. Including patients at various levels of disability and chronicity might help determine for which level of disability and/or level of pain chronicity this type of treatment is effective.

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