Effects of Different Treatment Methods Applied to Spine in Chronic Non-Spesific Low Back Pain

Study Overview
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Brief Summary
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We aimed to investigate the effects of instrument assisted manipulation (IAM) and Mulligan mobilization with movement (MWM) on joint range of motion (ROM), pain, proprioception, endurance, back awareness and disability in individuals with chronic non-specific low back pain (CNSLBP). Fifthy one participants were randomly divided into 3 groups. The first was the Mulligan group, the second was the IAM group, and the third was the core exercise group. Visual Analogue Scale (VAS) was used to assess pain severity. Lumbal flexibility was evaluated with the fingertip-to-floor test. Oswestry disability index (ODI) and Roland Morris Disability Questionnaire (RMDQ) used to evaluate the disability. Fremantle back awareness questionnaire (FBAQ) used to evaluate back awareness. Joint ROM (lumbal flexion, lumbal extension and lumbal lateral flexion) and proprioception (30° lumbal flexion in standing, 30° lumbal flexion in sitting, 15° lumbal extension standing and lumbal neutral position) evaluated with JTECH digital dual inclinometer. McGill core endurance tests were used for core endurance assessment. McGill core endurance assessment consists of 3 tests. These: Flexor endurance test, lateral endurance test and extensor endurance test.

Detailed Description
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IAM and Mulligan MWM interventions were applied 3 days a week for 2 weeks in total 6 sessions. All 3 groups did same core exercise program. The exercise program was done from the baseline for 6 weeks, 3 days a week, for a total of 18 sessions. Outcome measurements were done at baseline, at the end of the 2nd week, and at the end of the 6th week. The researcher who performed the outcome measurements did not know the participant's group. Assessment and treatment were performed by two different researchers with 8 years of professional experience. Visual Analogue Scale (VAS) was used to assess pain severity. Lumbal flexibility was evaluated with the fingertip-to-floor test. Oswestry disability index (ODI) and Roland Morris Disability Questionnaire (RMDQ) used to evaluate the disability. Fremantle back awareness questionnaire (FBAQ) used to evaluate back awareness. Joint ROM (lumbal flexion, lumbal extension and lumbal lateral flexion) and proprioception (30° lumbal flexion in standing, 30° lumbal flexion in sitting, 15° lumbal extension standing and lumbal neutral position) evaluated with JTECH digital dual inclinometer. The measurement of the joint ROM in the lumbal region with the dual inclinometer technique is a reliable method. McGill core endurance tests were used for core endurance assessment. McGill core endurance assessment consists of 3 tests. These: Flexor endurance test, lateral endurance test and extensor endurance test.

Official Title
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Effects of Different Treatment Methods Applied to Spine in Chronic Non-Spesific Low Back Pain: A Randomized Controlled Trial

Conditions
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Chronic Low-back Pain

Intervention / Treatment
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* Other: Instrument assisted manipulation + Core exercises
* Other: Mulligan mobilization with movement + Core exercises
* Other: Core exercises


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: LBP for at least 3 months Diagnosis of non-specific LBP 20-55 ages. Exclusion Criteria: Red flag symptoms related to LBP Neurological findings Pain radiating to the leg Undergone spinal surgery Pathology of the spine (fracture, tumor, spondylolisthesis, spinal stenosis, cauda equina syndrome).

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

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
Interventional Model Description: Randomized Controlled Trial
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Instrument Assisted Manipulation Group<br>Instrument Assisted Manipulation + Core exercises | Other: Instrument assisted manipulation + Core exercises<br>* The effect of Instrument assisted manipulation on chronic non-spesific low back pain<br>|
| Experimental: Mulligan Mobilization with Movement Group<br>Mulligan Mobilization with Movement + Core exercises | Other: Mulligan mobilization with movement + Core exercises<br>* The effect of Mulligan mobilization with movement on chronic non-spesific low back pain<br>|
| Active Comparator: Control group<br>Core exercises | Other: Core exercises<br>* The effect of core exercises on chronic non-spesific low back pain<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline visual analogue scale at 2nd and 6th weeks | Pain assessment. The minimum score of the visual analogue scale is 0, and the maximum score is 10. Higher scores indicate worse outcome. | Baseline, 2nd week, 6th week | 
| Change from baseline fingertip-to-floor test at 2nd and 6th weeks | Lumbal flexibility | Baseline, 2nd week, 6th week | 
| Change from baseline joint ROM measurement with digital inclinometer at 2nd and 6th weeks | Lumbal flexion, lumbal extension and lumbal lateral flexion | Baseline, 2nd week, 6th week | 
| Change from baseline proprioception measurement with digital inclinometer at 2nd and 6th weeks | 30° lumbal flexion in standing, 30° lumbal flexion in sitting, 15° lumbal extension standing and lumbal neutral position | Baseline, 2nd week, 6th week | 
| Change from baseline Oswestry disability index at 2nd and 6th weeks | Disability assessment. The minimum score of the Oswestry disability index is 0, and the maximum score is 50. Higher scores indicate worse outcome. | Baseline, 2nd week, 6th week | 
| Change from baseline Roland Morris disability questionnaire at 2nd and 6th weeks | Disability assessment. The minimum score of the Roland Morris disability questionnaire is 0, and the maximum score is 24. Higher scores indicate worse outcome. | Baseline, 2nd week, 6th week | 
| Change from baseline Fremantle back awareness questionnaire at 2nd and 6th weeks | Back awareness assessment. The minimum score of the Fremantle back awareness questionnaire is 0, and the maximum score is 36. Higher scores indicate worse outcome. | Baseline, 2nd week, 6th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Chronic Low Back Pain, Physiotherapy, Mulligan, Instrument Assisted Manipulation, Core Exercise