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document
Trunk exercise combined with spinal manipulative or NSAID therapy for chronic low back pain : a randomized , observer-blinded clinical trial . OBJECTIVES To study the relative efficacy of three different treatment for chronic low back pain ( CLBP ) . Two preplanned comparisons were made : ( a ) Spinal manipulative therapy ( SMT ) combined with trunk strengthening exercises ( TSE ) vs. SMT combined with trunk stretching exercises , and ( b ) SMT combined with TSE vs. nonsteroidal anti-inflammatory drug ( NSAID ) therapy combined with TSE . STUDY DESIGN Interdisciplinary , prospective , observer-blinded , randomized clinical trial with a 1-yr follow-up period . The trial evaluated therapies in combination only and was not designed to test the individual treatment components . SETTING Primary contact , college out-patient clinic . PATIENTS In total , 174 patients aged 20-60 yr were admitted to the study . MAIN OUTCOME MEASURES Patient-rated low back pain , disability , and functional health status at 5 and 11 wk . INTERVENTIONS Five weeks of SMT or NSAID therapy in combination with supervised trunk exercise , followed by and additional 6 wk of supervised exercise alone . RESULTS Individual group comparisons after 5 and 11 wk of intervention on all three main outcome measures did not reveal any clear clinically important or statistically significant differences . There seemed to be a sustained reduction in medication use at the 1-yr follow-up . in the SMT/TSE group . Continuance of exercise during the follow-up year , regardless of type , was associated with a better outcome . CONCLUSION Each of the three therapeutic regimens was associated with similar and clinically important improvement over time that was considered superior to the expected natural history of long-standing CLBP . For the management of CLBP , trunk exercise in combination with SMT or NSAID therapy seemed to be beneficial and worthwhile . The magnitude of nonspecific therapeutic ( placebo ) effects , cost-effectiveness and relative risks of side effects associated with these types of therapy need to be addressed in future studies .
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Intervention_Physical
Trunk exercise combined with spinal manipulative
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Intervention_Pharmacological
NSAID therapy
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Intervention_Physical
Spinal manipulative therapy ( SMT ) combined with trunk strengthening exercises ( TSE ) vs. SMT combined with trunk stretching exercises , and
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Intervention_Physical
SMT combined with TSE
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Intervention_Pharmacological
nonsteroidal anti-inflammatory drug ( NSAID ) therapy combined with TSE
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Intervention_Physical
SMT
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Intervention_Pharmacological
NSAID
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Intervention_Physical
therapy in combination with supervised trunk exercise
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Intervention_Physical
supervised exercise alone .
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Intervention_Physical
SMT
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Intervention_Pharmacological
NSAID therapy
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Intervention_Control
( placebo )
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Outcome_Pain
Patient-rated low back pain
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Outcome_Physical
disability
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Outcome_Physical
functional health status
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Outcome_Other
reduction in medication use at the 1-yr follow-up
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Participant_Condition
chronic low back pain
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Participant_Condition
chronic low back pain
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Participant_Sample-size
174
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Participant_Age
20-60