Effectiveness of manual therapy on low back pain with working adults

M.Sc. Markku Paatelma defends his doctoral dissertationtitled "Orthopaedic manual therapyonlow back pain with working adults; clinical tests, subclassificationand clinical trial of low back pain”. Opponent Docent Markku Kankaanpää (Pirkanmaa Hospital District) and custos Professor Ari Heinonen (University of Jyväskylä).

Abstract-

Orthopedic manual therapy on low back pain with working adults; clinical tests, subclassificationand clinical trial of low back pain. Although the natural history of low back pain (LBP) is considered to be good, most sufferers have further episodes during the first year. Debate continuesonthe comparative effectiveness of adviceonbed rest and staying active as part of the primary care management to avoid a vicious circle, preventing LBP from becoming chronic in its early phase (of < 12-week duration). LBP in its early phase is also a commonreasonto consult aphysiotherapist.The objective of this dissertationwas to evaluate the intertester and intratester reliability of selected clinical tests betweenphysiotherapists to assess LBP patients in the early phase, and to discover the sensitivity and specificity of these tests in acute/subacute and chronic LBP patients, and in a group of no “patient status” subjects. A further objective was to evaluate the intertester reliability of a pathoanatomical/pathophysiological classificationby general practitioners in primary carephysiotherapy compared to findings classified by a specialist in orthopedic manual therapy (OMT) and the findings of two OMT specialists when examining patients with early-phase LBP using selected clinical tests. The objective was also to compare effectiveness against low back and leg pain, disability, and sick leave of OMTphysiotherapy using a pathoanatomical/pathophysiological classificationto the effectiveness of the McKenzie method and effectiveness of “Advice”only to stay active.The inter- and intratester reliability of clinical tests seemed to be at an acceptable level globally, although tests had both high and low reliability among test categories. Intratester reliability was slightly better than intertester reliability.Of all the selected clinical tests, few tests were moderately sufficient in sorting the chronic low back pain patients (CLBP) from subacute low back pain patients (SLBP), and distinguishing patient groups from controls. These 31 clinical tests quite poorly sorted the CLBP or SLBP patients from the controls. It may be possible that a combinationof tests may enhance the sensitivity and specificity in sorting the CLBP or SLBP patients from the controls.Subclassificationinto clinical subgroups is reliable in the two most commonsubgroups also withphysiotherapists without specializationin OMT after a short post-graduate training. No further conclusioncould be drawn from other subgroups because of the low number of subjects in these categories.The OMT and McKenzie methods, compared to Advice-only to stay active for low back and leg pain, and disability showed no significant difference in effectiveness during aone-year follow-up of working adults. However, the OMT and McKenzie method groups showed treatment effects compared to the Advice-only group in form of the smaller number of days of sick leave because of LBP. Regarding sick leave days, there was also a statistically significant difference between OMT and McKenzie groups in favor of OMT-physiotherapy.Keywords: orthopedic manual therapy, McKenzie method, clinical tests, sub-classification, low back pain in early phase, randomized controlled trial.

For further information:
Markku Paatelma, tel. 040 501 4822, email- markku.paatelma@auron.fi

The dissertationis published in the series Jyväskylä Studies in Sport, Physical Educationand Health, no173, 98 p., Jyväskylä, 2011, ISBN 978-951-39-4428-5, ISSN 0356-1070.