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Conservative care with or without manipulative therapy in the management of back and/or neck pain in Danish children aged 9–15: a randomised controlled trial nested in a school-based cohort
BACKGROUND: A substantial number of children experience spinal pain, that is, back and/or neck pain. Today, no ‘gold-standard’ treatment for spinal pain in children exists, but manipulative therapy is increasingly being used in spite of a lack of evidence of its effectiveness. This study investigate...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6144397/ https://www.ncbi.nlm.nih.gov/pubmed/30206079 http://dx.doi.org/10.1136/bmjopen-2017-021358 |
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author | Dissing, Kristina Boe Hartvigsen, Jan Wedderkopp, Niels Hestbæk, Lise |
author_facet | Dissing, Kristina Boe Hartvigsen, Jan Wedderkopp, Niels Hestbæk, Lise |
author_sort | Dissing, Kristina Boe |
collection | PubMed |
description | BACKGROUND: A substantial number of children experience spinal pain, that is, back and/or neck pain. Today, no ‘gold-standard’ treatment for spinal pain in children exists, but manipulative therapy is increasingly being used in spite of a lack of evidence of its effectiveness. This study investigates the effectiveness of adding manipulative therapy to other conservative care for spinal pain in a school-based cohort of Danish children aged 9–15 years. METHODS AND FINDINGS: The design was a two-arm pragmatic randomised controlled trial, nested in a longitudinal open cohort study in Danish public schools. 238 children from 13 public schools were randomised individually from February 2012 to April 2014. A text message system and clinical examinations were used for data collection. Interventions included either (1) advice, exercises and soft-tissue treatment or (2) advice, exercises and soft-tissue treatment plus manipulative therapy. The primary outcome was number of recurrences of spinal pain. Secondary outcomes were duration of spinal pain, change in pain intensity and Global Perceived Effect. We found no significant difference between groups in the primary outcome (control group median 1 (IQR 1–3) and intervention group 2 (IQR 0–4), p=0.07). Children in the group receiving manipulative therapy reported a higher Global Perceived Effect: OR 2.22, (95% CI 1.19 to 4.15). No adverse events were reported. Main limitations are the potential discrepancy between parental and child reporting and that the study population may not be comparable to a normal care-seeking population. CONCLUSIONS: Adding manipulative therapy to other conservative care in school children with spinal pain did not result in fewer recurrent episodes. The choice of treatment—if any—for spinal pain in children therefore relies on personal preferences, and could include conservative care with and without manipulative therapy. Participants in this trial may differ from a normal care-seeking population. TRIAL REGISTRATION NUMBER: NCT01504698; Results. |
format | Online Article Text |
id | pubmed-6144397 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-61443972018-09-21 Conservative care with or without manipulative therapy in the management of back and/or neck pain in Danish children aged 9–15: a randomised controlled trial nested in a school-based cohort Dissing, Kristina Boe Hartvigsen, Jan Wedderkopp, Niels Hestbæk, Lise BMJ Open Rehabilitation Medicine BACKGROUND: A substantial number of children experience spinal pain, that is, back and/or neck pain. Today, no ‘gold-standard’ treatment for spinal pain in children exists, but manipulative therapy is increasingly being used in spite of a lack of evidence of its effectiveness. This study investigates the effectiveness of adding manipulative therapy to other conservative care for spinal pain in a school-based cohort of Danish children aged 9–15 years. METHODS AND FINDINGS: The design was a two-arm pragmatic randomised controlled trial, nested in a longitudinal open cohort study in Danish public schools. 238 children from 13 public schools were randomised individually from February 2012 to April 2014. A text message system and clinical examinations were used for data collection. Interventions included either (1) advice, exercises and soft-tissue treatment or (2) advice, exercises and soft-tissue treatment plus manipulative therapy. The primary outcome was number of recurrences of spinal pain. Secondary outcomes were duration of spinal pain, change in pain intensity and Global Perceived Effect. We found no significant difference between groups in the primary outcome (control group median 1 (IQR 1–3) and intervention group 2 (IQR 0–4), p=0.07). Children in the group receiving manipulative therapy reported a higher Global Perceived Effect: OR 2.22, (95% CI 1.19 to 4.15). No adverse events were reported. Main limitations are the potential discrepancy between parental and child reporting and that the study population may not be comparable to a normal care-seeking population. CONCLUSIONS: Adding manipulative therapy to other conservative care in school children with spinal pain did not result in fewer recurrent episodes. The choice of treatment—if any—for spinal pain in children therefore relies on personal preferences, and could include conservative care with and without manipulative therapy. Participants in this trial may differ from a normal care-seeking population. TRIAL REGISTRATION NUMBER: NCT01504698; Results. BMJ Publishing Group 2018-09-10 /pmc/articles/PMC6144397/ /pubmed/30206079 http://dx.doi.org/10.1136/bmjopen-2017-021358 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Rehabilitation Medicine Dissing, Kristina Boe Hartvigsen, Jan Wedderkopp, Niels Hestbæk, Lise Conservative care with or without manipulative therapy in the management of back and/or neck pain in Danish children aged 9–15: a randomised controlled trial nested in a school-based cohort |
title | Conservative care with or without manipulative therapy in the management of back and/or neck pain in Danish children aged 9–15: a randomised controlled trial nested in a school-based cohort |
title_full | Conservative care with or without manipulative therapy in the management of back and/or neck pain in Danish children aged 9–15: a randomised controlled trial nested in a school-based cohort |
title_fullStr | Conservative care with or without manipulative therapy in the management of back and/or neck pain in Danish children aged 9–15: a randomised controlled trial nested in a school-based cohort |
title_full_unstemmed | Conservative care with or without manipulative therapy in the management of back and/or neck pain in Danish children aged 9–15: a randomised controlled trial nested in a school-based cohort |
title_short | Conservative care with or without manipulative therapy in the management of back and/or neck pain in Danish children aged 9–15: a randomised controlled trial nested in a school-based cohort |
title_sort | conservative care with or without manipulative therapy in the management of back and/or neck pain in danish children aged 9–15: a randomised controlled trial nested in a school-based cohort |
topic | Rehabilitation Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6144397/ https://www.ncbi.nlm.nih.gov/pubmed/30206079 http://dx.doi.org/10.1136/bmjopen-2017-021358 |
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