Does the evidence for spinal manipulation translate into better outcomes in routine clinical care for patients with occupational low back pain? A case-control study.

BACKGROUND CONTEXT: Previous research has identified clinical characteristics of patients who are likely to respond favorably to thrust manipulation. The application of this evidence and its effect on clinical outcomes among patients with occupational low back pain has not been examined. PURPOSE: Examine patients treated in physical therapy with occupational low back pain who fit a subgroup likely to respond to thrust manipulation. STUDY DESIGN/SETTING: Retrospective review of clinical database. PATIENT SAMPLE: Patients with low back pain of less than 16 days duration with no symptoms distal to the knee or signs of nerve root compression receiving workers' compensation and referred to physical therapy were included. OUTCOME MEASURES: Self-report measures: numeric pain rating and Oswestry disability questionnaire. FUNCTIONAL MEASURES: Number of visits, duration, and costs of physical therapy. METHODS: Physical therapy notes for the first two sessions were examined. Patients were categorized as having received thrust manipulation, nonthrust manipulation, or no manipulation. Pain intensity and disability were recorded at initial and final sessions. The number of sessions, length of stay, and costs of physical therapy were recorded. Comparisons were made between patients receiving manipulation versus no manipulation, and between those receiving thrust versus nonthrust manipulation. RESULTS: Two hundred fifteen patients were included (mean age 35.9 [+/-10.1] years, 67.9% male). Thrust manipulation was received by 107 (49.8%) patients; 36 (16.7%) received nonthrust manipulation and 72 (33.5%) received no manipulation. Patients receiving manipulation (thrust or nonthrust) experienced greater reductions in pain and disability with treatment. Patients receiving thrust manipulation had fewer sessions, a shorter length of stay, and lower costs in physical therapy than patients receiving nonthrust manipulation. CONCLUSIONS: The evidence supporting superior clinical outcomes with the use of manipulation for a subgroup of patients was corroborated by this retrospective review of patients with occupational low back pain. The use of thrust manipulation appeared to be more efficient than the use of nonthrust manipulation for these patients.