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Abstract：
BACKGROUND: Clinical practice guidelines recommend spinal manipulation for patients with low back pain. However, the effects of spinal manipulation have contradictory findings compared to placebo intervention. Therefore, this study investigated the immediate effects of lumbar spinal manipulation on pressure pain threshold (PPT) and postural stability in people with chronic low back pain (cLBP). Second, we investigated the immediate effect of lumbar spinal manipulation on pain intensity and the interference of the participant beliefs about which treatment was received in the PPT, postural stability, and pain intensity.
METHODS: A two-arm, randomised, placebo-controlled, double-blind trial was performed. Eighty participants with nonspecific cLPB and a minimum score of 3 on the Numeric Pain Rating Scale received one session of lumbar spinal manipulation (n = 40) or simulated lumbar spinal manipulation (n = 40). Primary outcomes were local and remote PPTs and postural stability. Secondary outcomes were pain intensity and participant\'s perceived treatment allocation. Between-group mean differences and their 95% confidence intervals (CIs) estimated the treatment effect. One-way analysis of covariance (ANCOVA) was performed to assess whether beliefs about which treatment was received influenced the outcomes.
RESULTS: Participants had a mean (SD) age of 34.9 (10.5) years, and 50 (62.5%) were women. Right L5 [between-group mean difference = 0.55 (95%CI 0.19 to 0.90)], left L5 [between-group mean difference = 0.45 (95%CI 0.13 to 0.76)], right L1 [between-group mean difference = 0.41 (95%CI 0.05 to 0.78)], left L1 [between-group mean difference = 0.57 (95%CI 0.15 to 0.99)], left DT [between-group mean difference = 0.35 (95%CI 0.04 to 0.65)], and right LE [between-group mean difference = 0.34 (95%CI 0.08 to 0.60)] showed superior treatment effect in the spinal manipulation group than sham. Neither intervention altered postural stability. Self-reported pain intensity showed clinically significant decreases in both groups after the intervention. A higher proportion of participants in the spinal manipulation group achieved more than two points of pain relief (spinal manipulation = 90%; sham = 60%). The participants\' perceived treatment allocation did not affect the outcomes.
CONCLUSIONS: One spinal manipulation session reduces lumbar pain sensitivity but does not affect postural stability compared to a sham session in individuals with cLPB. Self-reported pain intensity lowered in both groups and a higher proportion of participants in the spinal manipulation group reached clinically significant pain relief. The participant\'s belief in receiving the manipulation did not appear to have influenced the outcomes since the adjusted model revealed similar findings.
METHODS: A two-arm, randomised, placebo-controlled, double-blind trial was performed. Eighty participants with nonspecific cLPB and a minimum score of 3 on the Numeric Pain Rating Scale received one session of lumbar spinal manipulation (n = 40) or simulated lumbar spinal manipulation (n = 40). Primary outcomes were local and remote PPTs and postural stability. Secondary outcomes were pain intensity and participant\'s perceived treatment allocation. Between-group mean differences and their 95% confidence intervals (CIs) estimated the treatment effect. One-way analysis of covariance (ANCOVA) was performed to assess whether beliefs about which treatment was received influenced the outcomes.
RESULTS: Participants had a mean (SD) age of 34.9 (10.5) years, and 50 (62.5%) were women. Right L5 [between-group mean difference = 0.55 (95%CI 0.19 to 0.90)], left L5 [between-group mean difference = 0.45 (95%CI 0.13 to 0.76)], right L1 [between-group mean difference = 0.41 (95%CI 0.05 to 0.78)], left L1 [between-group mean difference = 0.57 (95%CI 0.15 to 0.99)], left DT [between-group mean difference = 0.35 (95%CI 0.04 to 0.65)], and right LE [between-group mean difference = 0.34 (95%CI 0.08 to 0.60)] showed superior treatment effect in the spinal manipulation group than sham. Neither intervention altered postural stability. Self-reported pain intensity showed clinically significant decreases in both groups after the intervention. A higher proportion of participants in the spinal manipulation group achieved more than two points of pain relief (spinal manipulation = 90%; sham = 60%). The participants\' perceived treatment allocation did not affect the outcomes.
CONCLUSIONS: One spinal manipulation session reduces lumbar pain sensitivity but does not affect postural stability compared to a sham session in individuals with cLPB. Self-reported pain intensity lowered in both groups and a higher proportion of participants in the spinal manipulation group reached clinically significant pain relief. The participant\'s belief in receiving the manipulation did not appear to have influenced the outcomes since the adjusted model revealed similar findings.
摘要：
背景：临床实践指南建议对腰背痛患者进行脊柱推拿。然而,与安慰剂干预相比,脊柱操作的效果有矛盾的发现.因此,这项研究调查了腰椎操作对慢性下腰痛（cLBP）患者的压力痛阈值（PPT）和姿势稳定性的直接影响。第二,我们调查了腰椎操作对疼痛强度的直接影响，以及在PPT中接受治疗的参与者信念的干扰，姿势稳定性，和疼痛强度。
方法：双臂，随机化，安慰剂对照,进行了双盲试验.80名具有非特异性cLPB且在数字疼痛评定量表上最低得分为3的参与者接受了一次腰椎脊柱操纵（n=40）或模拟腰椎脊柱操纵（n=40）。主要结果是本地和远程PPTs和姿势稳定性。次要结果是疼痛强度和参与者感知的治疗分配。组间平均差异和它们的95%置信区间(CI)估计了治疗效果。进行单因素协方差分析(ANCOVA)以评估关于接受哪种治疗的信念是否影响结果。
结果：参与者的平均（SD）年龄为34.9（10.5）岁，50名(62.5%)为女性。右L5[组间平均差=0.55（95CI0.19至0.90）]，左L5[组间平均差异=0.45（95CI0.13至0.76）]，右L1[组间平均差=0.41（95CI0.05至0.78）]，左L1[组间平均差=0.57（95CI0.15至0.99）]，左DT[组间平均差=0.35（95CI0.04至0.65）]，右侧LE[组间平均差异=0.34（95CI0.08至0.60）]在脊柱操作组中显示出比假手术更好的治疗效果。两种干预都没有改变姿势稳定性。干预后，两组的自我报告疼痛强度均显示临床上显着降低。脊柱操纵组的参与者比例更高（脊柱操纵=90％；假手术=60％），可以减轻两个以上的疼痛。参与者感知的治疗分配不影响结果。
结论：与cLPB患者的假手术相比，一次脊柱操作会降低腰椎疼痛敏感性，但不会影响姿势稳定性。两组自我报告的疼痛强度均降低，脊柱操纵组的参与者比例更高，达到临床上显着的疼痛缓解。参与者对接受操纵的信念似乎没有影响结果，因为调整后的模型揭示了类似的发现。
方法：双臂，随机化，安慰剂对照,进行了双盲试验.80名具有非特异性cLPB且在数字疼痛评定量表上最低得分为3的参与者接受了一次腰椎脊柱操纵（n=40）或模拟腰椎脊柱操纵（n=40）。主要结果是本地和远程PPTs和姿势稳定性。次要结果是疼痛强度和参与者感知的治疗分配。组间平均差异和它们的95%置信区间(CI)估计了治疗效果。进行单因素协方差分析(ANCOVA)以评估关于接受哪种治疗的信念是否影响结果。
结果：参与者的平均（SD）年龄为34.9（10.5）岁，50名(62.5%)为女性。右L5[组间平均差=0.55（95CI0.19至0.90）]，左L5[组间平均差异=0.45（95CI0.13至0.76）]，右L1[组间平均差=0.41（95CI0.05至0.78）]，左L1[组间平均差=0.57（95CI0.15至0.99）]，左DT[组间平均差=0.35（95CI0.04至0.65）]，右侧LE[组间平均差异=0.34（95CI0.08至0.60）]在脊柱操作组中显示出比假手术更好的治疗效果。两种干预都没有改变姿势稳定性。干预后，两组的自我报告疼痛强度均显示临床上显着降低。脊柱操纵组的参与者比例更高（脊柱操纵=90％；假手术=60％），可以减轻两个以上的疼痛。参与者感知的治疗分配不影响结果。
结论：与cLPB患者的假手术相比，一次脊柱操作会降低腰椎疼痛敏感性，但不会影响姿势稳定性。两组自我报告的疼痛强度均降低，脊柱操纵组的参与者比例更高，达到临床上显着的疼痛缓解。参与者对接受操纵的信念似乎没有影响结果，因为调整后的模型揭示了类似的发现。
