Effect of Mulligan Mobilization in Chronic Non-Spesific Low Back Pain

Study Overview
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Brief Summary
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Fifty five participants diagnosed with CNSLBP, will randomized into three groups. Group I (18 subjects) will receive 15 sessions of Conventional Physiotherapy program (CPP) 5 times per week, Group II (19 subjects) will receive 9 sessions of SNAGs, and Group III will receive CPP plus SNAGs. Outcome measures are pain, ROM, spinal mobility, fear avoidance behaviour and function. Measurements will record before, after and 6 month after the end of the treatment.

Detailed Description
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Inclussion criterias are; low back pain for at least 3 months, intensity of pain ranges from 3 to 6 according to VAS. Exclussion criterias are; undergoing surgical operation in the lumbar region or having a surgical indication, having an exercise therapy and / or physical therapy in the last 1 year, a history of trauma involving lumbar region and systemic and inflammatory disease targeting this region, participants using corticosteroids for a long time and being pregnant.Acording to our criterias 55 participants diagnosed with CNSLBP will randomised into three groups. Group 1 will receive Conventional Physiotherapy programme consisting of Hot pack, US and TENS applications. Group II aill receive Lumbar SNAGS consisting of Lumbar Extension SNAGS in prone, SNAGS in lion position and Lumbar flexion SNAGS in sitting, techniques. Group III will receive 9 sessions of SNAGs, and Group III will receive CPP plus SNAGs.Outcome measures are pain, ROM, spinal mobility, fear avoidance behaviour and function. Measurements will record before, after and 6 month after the end of the treatment. All treatment groups were treated with the same researcher. All assessments were made by another blind researcher three times at before, after and 6 month after treatment.

Official Title
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Efficacy of Mulligan Mobilization Technique in Chronic Non-Spesific Low Back Pain

Conditions
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Chronic Pain

Intervention / Treatment
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* Procedure: Conventional Physiotherapy
* Procedure: Mulligan Mobilization


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: low back pain for at least 3 months intensity of pain ranges from 3 to 6 according to VAS Exclusion Criteria: undergoing surgical operation in the lumbar region or having a surgical indication having an exercise therapy and / or physical therapy in the last 1 year a history of trauma involving lumbar region and systemic and inflammatory disease targeting this region corticosteroids consumption for a long time being pregnant.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Conventional Physiotherapy Group<br>Group I (18 subjects) received 15 sessions of Conventional Physiotherapy program (CPP) 5 times per week. | Procedure: Conventional Physiotherapy<br>* Conventional Physiotherapy consist of Hotpacks, TENS and US.The participants were positioned in prone and supported with a pillow under the abdomen, 20 min hot pack was applied. Therapatic Ultrason were applied with the frequency of 1 MHz, intensity of 1,5 watt/cm² and duration of 5 minute. TENS was applied to the lumbar region with 2-channel, 4 surface electrodes at 60-120 Hz, and 50-100 pulse duration for 20 minutes.<br>|
| Experimental: Mulligan Mobilization Group<br>Mulligan Mobilization was administered 9 sessions (3 days a week, for 3 weeks). . | Procedure: Mulligan Mobilization<br>* Extension SNAGS in prone, SNAGS in lion position and Lumbar flexion SNAGS in sitting, techniques were used. The techniques were applied in 3 sets with 10 repetitions and 60 seconds rest between sets.<br>* Other names: Lumbal SNAGs;|
| Experimental: Conventional Physiotherapy plus Mulligan Mobilization Group<br>Conventional Physiotherapy (15 session) plus Mulligan Mobilization Programme (9 session) were applied in this group. CP were applied 5 days a week and CP+MM 3 days a week for 3 weeks. | Procedure: Conventional Physiotherapy<br>* Conventional Physiotherapy consist of Hotpacks, TENS and US.The participants were positioned in prone and supported with a pillow under the abdomen, 20 min hot pack was applied. Therapatic Ultrason were applied with the frequency of 1 MHz, intensity of 1,5 watt/cm² and duration of 5 minute. TENS was applied to the lumbar region with 2-channel, 4 surface electrodes at 60-120 Hz, and 50-100 pulse duration for 20 minutes.<br>Procedure: Mulligan Mobilization<br>* Extension SNAGS in prone, SNAGS in lion position and Lumbar flexion SNAGS in sitting, techniques were used. The techniques were applied in 3 sets with 10 repetitions and 60 seconds rest between sets.<br>* Other names: Lumbal SNAGs;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of Range of Motion from baseline at 3 weeks and from baseline at 6 months | ROM is measured by BROM II device during flexion and extension activity. | Baseline, 3 weeks,6 months | 
| Change of Spinal Mobility from baseline at 3 weeks and from baseline at 6 months | Spinal mobility measured by Schober test. | Baseline, 3 weeks,6 months | 
| Change from Pain Intensity from baseline at 3 weeks and from baseline at 6 months | Pain intensity during flexion and extension activity in lumbar region is measured by Numeric pain scale in which 0 shows No pain while 10 shows worst pain. | Baseline, 3 weeks,6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Fear Avoidance Behaviour from baseline at 3 weeks and from baseline at 6 months | It ıs measured by Fear Avoidance Behaviour Questionnaire-Turkish.The total score ranges from 0 to 96. Maximum score indicates increased fear avoidanve behaviour | Baseline, 3 weeks,6 months | 
| Change from Disability level from baseline at 3 weeks and from baseline at 6 months | It ıs measured by measured by Rolland Morris Disability Questionnaire-Turkish.Total score ranked from 0 to 24. İncreased score represents disability in functional activities | Baseline, 3 weeks,6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lumbal SNAGs, efficiency