The Effects of Spinal Manipulation Added to Exercise on Pain and Quality of Life in Patients with Thoracic Spinal Pain: A Randomized Controlled Trial

Abstract

Background. There are not enough reliable studies available in physiotherapy to determine the effects of spinal manipulative therapy added to exercise on thoracic spinal pain and quality of life. Objective. To investigate the effects of spinal manipulation on pain and quality of life in subjects with thoracic spinal pain. Study Design. It was an open-label "randomized controlled trial."Study Settings. Department of Physiotherapy, Services Hospital, Lahore, Pakistan. Participants. There were one hundred subjects with an age group between 18 and 60 years fulfilling the inclusion criteria. These subjects were divided equally into two groups; an experimental and a control group. Methods. In the experimental group (n=50), thoracic spinal manipulation was applied along with thoracic muscle strengthening exercises. In the control group (n=50) thoracic muscle exercises alone were given. Pain was measured by visual analogue scale (VAS) and quality of life with SF-36. Measurements were taken at baseline, immediately after session, after 8th session, and later as follow-ups at 12 weeks. Repeated measure ANOVA and independent sample T-test were used for within and between-group comparisons. Results. Mean age of subjects in control group was 38.56±12.44 and in experimental group was 36.02±11.32. Both groups demonstrated significant improvement in VAS score, and all domains of SF 36 but between-group comparison showed greater improvement in VAS of the experimental group compared to the baseline (P<0.05), but between-group comparison of 8th session to follow-up has shown that effects of exercise persist while health-related quality of life in spinal manipulation group was significantly reduced after discontinuation of treatment. After the 8th session, spinal manipulation group showed notable results in terms of pain (mean diff 1.14 (0.62, 1.65) 95% CI and all aspects of SF 36 (P value <0.05). However, after week 12 of follow-up, no significant difference (P value >0.05) was observed among the study groups for pain and quality of life. Conclusion. Spinal manipulation added to thoracic exercise was more effective than thoracic exercise alone for improving pain and quality of life at the end of 8th session of care. However, the inclusion of spinal manipulation was not found effective at the 12-week follow-up. This trial is registered with IRCT20190327043125N1.