RESUMEN
OBJECTIVES: To study the natural history of prolonged neck pain and the effectiveness of bone setting as its treatment. METHODS: A randomized clinical trial with blinded outcome assessment and 1-year follow-up was completed. Forty-two working-aged patients with nonspecific neck pain for at least 1 month and no contraindications to manipulative therapies were recruited. They were randomly allocated into 5 weekly sessions of bone setting provided by 2 experienced folk healers (22 patients) or follow-up without therapy (20 patients). The primary outcomes were neck mobility after the 5-week therapy period and the Million scales modified for neck pain at 5 weeks, and 3, 6, and 12 months after baseline. Secondary outcomes included self-rated improvement and pain drawing at 5 weeks, and 3, 6, and 12 months after baseline, Beck depression scales at 5 weeks and 12 months after baseline, and sick leaves, additional therapies, and pain medication during 1 year after baseline. RESULTS: At baseline, neck pain was reported constant or increasing by 51% and episodic by 49% of the patients with mean duration of symptoms of 4.3 years for the bone setting and 8.4 years for the control group. Seventy-eight percent of the patients participated in the clinical measurements at 5 weeks, and 90% returned the questionnaires after 1 year. The cervical mobility of the bone setting patients increased 29% in the frontal, 23% in the sagittal, and 16% in the horizontal plane, whereas the figures for the control group were -1.4%, 1.0%, and 3.0%, respectively. The mean Million index of the bone setting group (50.6 mm at baseline) was 18.5 mm at 5 weeks, 21.2 mm at 3 months, 22.9 mm at 6 months, and 14.2 mm at 1 year. The figures for the control group were 53.2 mm at baseline, and 4.0, 6.2, 5.4, and 5.5 mm at the corresponding follow-up points. After 1 year, improvement was reported by 80% of the bone setting and 28% of the control patients. CONCLUSION: In this study, manual therapy had a measurable effect on the mobility of cervical spine at 5 weeks and an effect on pain that lasted for at least half a year.
Asunto(s)
Manipulación Espinal , Dolor de Cuello/terapia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
STUDY DESIGN: A cohort of 114 primary care patients were studied for 1 year before and 1 year after a randomized clinical trial. OBJECTIVES: To explore the therapy use, societal costs, and quality of life of patients with prolonged back pain. To compare the effects of physiotherapy, bone setting, and light exercise therapy on these measures. SUMMARY OF BACKGROUND DATA: Analyses of back pain have mostly focused on the minority of patients who cause high costs and a heavy burden on national economies. The majority with low costs have aroused less interest. The patient's choice of therapy, especially alternative medicine, has seldom been evaluated despite the increasing popularity of alternative therapies. METHODS: Data were collected from the Social Insurance Institution files, patient records, and questionnaires: the Nottingham Health Profile (NHP). RESULTS: One year before enrollment a third of the patients had consulted primary care. Half of them had had some therapy: mainly massage, physiotherapy, naprapathy, or bone setting. One third of the direct costs were spent on complementary therapies and another third on rehabilitation. Sick leaves accounted for 55% of the total costs (US$ 1029). The mean total costs slightly increased after the randomized therapies (US$ 1306). The costs of ambulatory care, with the study therapies included, were similar, whereas physiotherapy seemed the cheapest (US$ 621) and bone setting the most expensive (US$ 2072) alternative in view of the total costs. More NHP subscales were improved by physiotherapy and bone setting than by exercise. CONCLUSIONS: A third of the direct back pain costs were spent on complementary therapies. The use of health care services and absenteeism tended to decrease after a course of physiotherapy. Physiotherapy and bone setting seemed able to improve the quality of life of patients with prolonged back pain.
Asunto(s)
Dolor de Espalda/economía , Dolor de Espalda/terapia , Medicina Familiar y Comunitaria/economía , Costos de la Atención en Salud/estadística & datos numéricos , Calidad de Vida , Adulto , Dolor de Espalda/epidemiología , Estudios de Cohortes , Costo de Enfermedad , Terapia por Ejercicio/economía , Terapia por Ejercicio/estadística & datos numéricos , Medicina Familiar y Comunitaria/estadística & datos numéricos , Femenino , Finlandia/epidemiología , Humanos , Masculino , Masaje/economía , Masaje/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud/economía , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Dimensión del Dolor , Especialidad de Fisioterapia/economía , Especialidad de Fisioterapia/estadística & datos numéricos , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
BACKGROUND: Chiropractic manipulation and strenuous exercise therapy have been shown effective in the treatment of nonspecific back pain. Bone-setting, the predecessor of modern manual therapies, still survives in some parts of Finland and was compared with a light exercise therapy and non-manipulative, pragmatic physiotherapy in a year-long randomized controlled trial on patients with long-term back pain. METHODS: One hundred fourteen ambulatory patients of working age with back pain for 7 weeks or more were randomly assigned to the therapies, which were offered in up to 10 sessions during a 6-week treatment period. The outcome was measured by the Oswestry Disability Questionnaire. Sick-leaves and visits to health centers were recorded for 1 year before and after the therapy. RESULTS: The Oswestry disability scores improved most in the bone-setting group (P =.02, Kruskall-Wallis test). Visits to health centers for back pain were reduced only in the physiotherapy group (P =.01, Wilcoxon test). Sick-leaves were not significantly different between groups. A secondary analysis based on the use of additional therapies after the intervention showed a possible subgroup with an enhanced effect from bone-setting. CONCLUSIONS: Traditional bone-setting seemed more effective than exercise or physiotherapy on back pain and disability, even 1 year after therapy.