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Outcomes for chronic neck and low back pain patients after manipulation under anesthesia: a prospective cohort study


Peterson, Cynthia K; Humphreys, B Kim; Vollenweider, Regina; Kressig, Michel; Nussbaumer, Rolf (2014). Outcomes for chronic neck and low back pain patients after manipulation under anesthesia: a prospective cohort study. Journal of Manipulative and Physiological Therapeutics, 37(6):377-382.

Abstract

BACKGROUND: The purpose of this study was to investigate outcomes of chronic patients unresponsive to previous spinal manipulative therapy subsequently treated with manipulation under anesthesia (MUA).
METHODS: A prospective outcome cohort study was performed on 30 patients who had not improved with previous treatment and who underwent a single MUA by a doctor of chiropractic. The numeric rating scale for pain (NRS) and Bournemouth Questionnaire (BQ) were collected at 2 weeks and 1 day before MUA. At 2 and 4 weeks after MUA, the Patient's Global Impression of Change, NRS, and BQ were collected. The intraclass correlation coefficient evaluated stability before treatment. Percentage of patients "improved" was calculated at 2 and 4 weeks. Wilcoxon test compared pretreatment NRS and BQ scores with posttreatment scores. Mann-Whitney U test compared individual questions on the BQ between improved and not improved patients. Logistic regression compared BQ questions to "improvement."
RESULTS: Good stability of NRS and BQ scores before MUA (intraclass correlation coefficient=0.46-0.95) was found. At 2 weeks, 52% of the patients reported improvement with 45.5% improved at 4 weeks. Significant reductions in NRS scores at 4 weeks (P=.01) and BQ scores at 2 (P=.008) and 4 weeks (P=.001) were reported. Anxiety/stress levels were significantly different at 2 and 4 weeks between improved and not improved patients (P=.007). None of the BQ questions were predictive of improvement.
CONCLUSION: Approximately half of patients previously unresponsive to conservative treatment reported clinically relevant improvement at 2 and 4 weeks post-MUA.

BACKGROUND: The purpose of this study was to investigate outcomes of chronic patients unresponsive to previous spinal manipulative therapy subsequently treated with manipulation under anesthesia (MUA).
METHODS: A prospective outcome cohort study was performed on 30 patients who had not improved with previous treatment and who underwent a single MUA by a doctor of chiropractic. The numeric rating scale for pain (NRS) and Bournemouth Questionnaire (BQ) were collected at 2 weeks and 1 day before MUA. At 2 and 4 weeks after MUA, the Patient's Global Impression of Change, NRS, and BQ were collected. The intraclass correlation coefficient evaluated stability before treatment. Percentage of patients "improved" was calculated at 2 and 4 weeks. Wilcoxon test compared pretreatment NRS and BQ scores with posttreatment scores. Mann-Whitney U test compared individual questions on the BQ between improved and not improved patients. Logistic regression compared BQ questions to "improvement."
RESULTS: Good stability of NRS and BQ scores before MUA (intraclass correlation coefficient=0.46-0.95) was found. At 2 weeks, 52% of the patients reported improvement with 45.5% improved at 4 weeks. Significant reductions in NRS scores at 4 weeks (P=.01) and BQ scores at 2 (P=.008) and 4 weeks (P=.001) were reported. Anxiety/stress levels were significantly different at 2 and 4 weeks between improved and not improved patients (P=.007). None of the BQ questions were predictive of improvement.
CONCLUSION: Approximately half of patients previously unresponsive to conservative treatment reported clinically relevant improvement at 2 and 4 weeks post-MUA.

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1 citation in Web of Science®
1 citation in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2014
Deposited On:18 Feb 2015 15:29
Last Modified:05 Apr 2016 18:53
Publisher:Elsevier
ISSN:0161-4754
Publisher DOI:https://doi.org/10.1016/j.jmpt.2014.05.002
PubMed ID:24998720

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