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Efficacy of Manipulative Treatment for Acute Low Back Pain in Active Duty Military Personnel

Journal: The Journal of the American Osteopathic Association Date: 2008/08, 108(8):Pages: 414. doi: Subito , type of study: randomized controlled trial

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2008.108.8.413/html)

Keywords:

low back pain [429]
military [16]
OMT [3102]
osteopathic manipulative treatment [3124]
randomized controlled trial [766]

Abstract:

This poster reports the findings of an efficacy study of manipulative treatment for acute low back pain (ALBP) in active duty military personnel. The Samueli Institute funded this study, conducted by the Osteopathic Research Center in 2006-07 at Fort Lewis Madigan Army Medical Center. Two primary outcome measures for this randomized, blinded, controlled clinical trial were pain (Visual Analog Scale), and functioning (Back Pain Functional Status Scale; Roland Morris Questionnaire [RMQ]). Other measures were patient expectation - treatment bias, restricted duty time, and medication use. ALBP was any acute event reported by a soldier, including a new episode (>30 day pain hiatus). We randomly assigned active duty male and female soldiers, ages 18-35, meeting inclusion/exclusion criteria, to a group receiving OMT plus routine care, or to a group receiving routine care-only. We evaluated all subjects on all measures at each of four once-a-week visits, and one month later. OMT was guided by somatic dysfunction (S/D) findings in: 1) Pelvic mobility and structural asymmetry, 2) Tenderpoint screening, 3) Lumbar segmental dysfunction. A standardized treatment protocol used ≤ six techniques based on S/D findings. No physical therapy was included, only standard analgesics. All IRBs approved. One-third of 225 soldiers screened met all criteria. Of 73 enrolled, nine were deployed prior to randomization and one was deployed before the second visit. Final analysis included 63 subjects: 33 OMT (81.8% - four visits) and 30 routine-care-only subjects (90% - four visits). Intention to treat analysis used descriptive and inferential statistics. OMT subjects reported significant improvement in pain (p\sc65.05) and RMQ scores (p<.05) compared to routine-care-only. Analysis of between-group differences found that the groups were similar in restricted duty time and medications. Subjects in the non-OMT group reported a significantly stronger belief in routine care alone for improving pain compared to the OMT group. When controlling for patient expectation scores, there were no differences between the two groups on “pain now” or on RMQ scores at visit 4 or at 2 months. Military personnel miss time from duty for musculoskeletal injuries more than for any other health condition. The findings from this study provide important information about the efficacy and feasibility of using OMT to restore peak performance f in military personnel with ALBP.


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