Evidence & Methods
Many nonsurgical interventions have been shown to make a small, but positive, impact on patients with chronic low back pain. This article compares three such interventions.
This is a prospective randomized clinical trial with 300 subjects having “mechanical back pain.” The authors found that supervised exercise aimed at trunk musculature provided better improvement in trunk strength than spinal manipulation or home exercise. Satisfaction was statistically better with the trunk strengthening program at some, but not all, data points. All other outcome measures, however, demonstrated no statistical differences between groups.
In a randomized clinical trial of this size, the chances of missing a major clinical superiority of one treatment are very small. The most impressive outcome appears to be the lack of clear and meaningful clinical advantage. In that respect, the study will likely be interpreted in different ways by different stakeholders. Some might focus on the demonstrable ability to increase trunk strength despite the failure of this outcome to translate into meaningful clinical differences. Others might be impressed by the unsupervised home exercise—a nearly “benign neglect” alternative—with little apparent clinical downside. Still others may cite the finding that popular chiropractic interventions produced similar outcomes despite a passive-patient approach. Previous work suggests that patient preference may be as important a clinical predictor as the actual intervention.
—The Editors