## 4 Discussion  
Our study results showed reduced LBP and disability and improved functional status after 12 MT sessions and a 6-week home-based therapeutic exercise program, as well as 12 sessions of physical therapy exercises supervised by a physiotherapist and 6 weeks of home-based therapeutic exercises. A previous study showed that eight MT sessions combined with core stabilization or aerobic exercise significantly reduced disability in individuals with LBP [32]. At the beginning of this study, the subjects described LBP as moderate pain and functional disability (ODI) as severe disability. After the intervention, they described LBP as mild pain and ODI as minimal disability. Therefore, after 12 MT sessions, pain reduced by 78% and ODI by 70%. After exercise therapy, the pain reduced 68% and ODI by 78%. Similar results with minor variation were also obtained by other researchers, who found a clinically and statistically significant reduction in pain and functional disability after 12 MT sessions [20,33]. Several studies investigating the effects of therapy on chronic LBP have based their findings on the statistical significance of the results rather than clinical relevance [34]. As defined by the practice guidelines for minimal clinically important difference (MCID), a clinically significant improvement occurs if, when comparing the pre- and post-treatment effects of individual treatment measures, LBP and functional disability are reduced by 30% compared to the initial level [29], or if the final ODI score is equal to or less than 20% [30]. In our study, the reduction in initial pain intensity levels and disability significantly exceeded the recommended MCID reduction of 30%. The positive results of our study may have been influenced by the optimal number of 12 MT and exercise therapy interventions over 6 weeks. These findings support the results of a previous study, where the best treatment effect was determined to be 12 MT interventions over 6 weeks for chronic nonspecific LBP and functional disability [20]. The reduction in disability may have been influenced by increased spine mobility after the intervention. Similar results have been reported by other researchers, who observed a decrease in spinal stiffness and mobility after MT in individuals with LBP [33,35,36,37]. \begin{table}
\begin{tabular}{c c c c c c c c c c c c} \hline \hline
**Variables** & **Group** & **Before** & \multicolumn{3}{c}{**Post**} & \multicolumn{3}{c}{**Within Group**} & \multicolumn{3}{c}{**Main Effect of Time**} \\ \hline  & & **mean \(\pm\) SD** & \(p\) & **mean \(\pm\) SD** & \(p\) & **F** & \(p\) & \(\eta_{\rm p}^{2}\) & **F** & \(p\) & \(\eta_{\rm p}^{2}\) \\ \hline Kinesiophobia & ETG & 42 \(\pm\) 3.2 & & 39 \(\pm\) 3.4 & & 15.1 & 0.00 & 0.71 & 193.6 & 0.00 & 0.77 \\ (scores) & MTG & 42 \(\pm\) 5 & & 36.2 \(\pm\) 4.2 & & 15.1 & 0.00 & 0.79 & & & \\  & ETG & 5.2 \(\pm\) 1 & & 7.2 \(\pm\) 1 & & 28.4 & 0.00 & 0.82 & & & \\  & MTG & 5.2 \(\pm\) 1 & & 7.3 \(\pm\) 0.5 & & 1.9 & 0.00 & 0.24 & & & \\ Pain (scores) & ETG & 6.3 \(\pm\) 1.2 & & 2 \(\pm\) 2.1 & & 9.4 & 0.00 & 0.41 & & & \\  & MTG & 6.3 \(\pm\) 1.5 & 0.99 & 1.4 \(\pm\) 1.4 & 0.23 & 4.9 & 0.00 & 0.51 & & & \\ Dissbility (\%) & ETG & 48 \(\pm\) 8.4 & & 10.5 \(\pm\) 9.4 & & 11.5 & 0.00 & 0.78 & & & & \\  & MTG & 47 \(\pm\) 10.5 & & 14 \(\pm\) 14.4 & & 42.2 & 0.00 & 0.99 & & & 453.4 & 0.00 & 0.89 \\ Abdominal muscle & ETG & 218 \(\pm\) 33.2 & & 293 \(\pm\) 17.3 & & 57.6 & 0.00 & 0.67 & & & & \\ endurance (s) & MTG & 218 \(\pm\) 68 & & 0.96 & 282 \(\pm\) 24.5 & & 0.03 & 24.2 & 0.00 & 0.79 & & & \\ Back muscle & ETG & 250 \(\pm\) 37.1 & & 300 \(\pm\) 0.3 & & 14.2 & 0.00 & 0.76 & & & & \\ endurance (s) & MTG & 250 \(\pm\) 56 & 1 & 294 \(\pm\) 14 & 0.02 & 48.6 & 0.00 & 0.78 & & & & \\ \hline  & & & & & & & & & & & \\ \end{tabular} Abbreviations: MTG—manual therapy group; ETG—exercise therapy group; \(\eta_{\rm p}^{2}\)—partial eta-squared. Note: x—All subjects in this group passed the maximum (300 s) Ito test time.  
\end{table}