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Published in: Trials 1/2019

Open Access 01-12-2019 | Leg Pain | Research

Comparative effectiveness of Chuna manual therapy versus conventional usual care for non-acute low back pain: a pilot randomized controlled trial

Authors: Kyeong-Tae Lim, Eui-Hyoung Hwang, Jae-Heung Cho, Jae-Young Jung, Koh-Woon Kim, In-Hyuk Ha, Me-riong Kim, Kibong Nam, Min ho Lee A, Jun-Hwan Lee, Namkwen Kim, Byung-Cheul Shin

Published in: Trials | Issue 1/2019

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Abstract

Background

Low back pain (LBP) is common, with a lifetime prevalence of 80%, and as such it places substantial social and economic burden on individuals and society. Chuna manual therapy (CMT) combines aspects of physiology, biodynamics of spine and joint motion, and basic theory of movement dynamics. This study aimed to test the comparative effectiveness and safety of CMT for non-acute LBP.

Methods

A three-arm, multicenter, pragmatic, randomized controlled pilot trial was conducted from 28 March 2016 to 19 September 2016, at four medical institutions. A total of 60 patients were randomly allocated to the CMT group (n = 20), usual care (UC) group (n = 20), or combined treatment (CMT + UC) group (n = 20), and received the relevant treatments for 6 weeks. The primary outcome was a numeric rating scale (NRS) representation of LBP intensity, while secondary outcomes included NRS of leg pain, Oswestry disability index (ODI), Patient Global Impression of Change (PGIC), the EuroQol-5 dimensions (EQ-5D), lumbar range of motion, and safety.

Results

A total of 60 patients were included in the intention-to-treat analysis and 55 patients (CMT, 18; UC, 18; CMT + UC, 19) were included in the per-protocol analysis (drop-out rate 5.3%). Over the treatment period there were significant differences in the NRS score for LBP (CMT mean − 3.28 (95% CI − 4.08, − 2.47); UC − 1.95 (− 2.82, − 1.08); CMT + UC − 1.75 (− 2.70, − 0.80), P < 0.01) and the ODI scores in each group (CMT − 12.29 (− 16.86, − 7.72); UC − 10.34 (− 14.63, − 6.06); CMT + UC − 9.27 (− 14.28, − 4.26), P < 0.01). The changes in other secondary outcomes did not significantly differ among the three groups. Sixteen minor-to-moderate safety concerns were reported.

Conclusions

Our results suggest that CMT has comparative efficacy for non-acute LBP and is generally safe. As this was a preliminary study, a well-powered (over 192 participants) two-arm (CMT versus UC) verification trial will be performed to assess the generalizability of these results.

Trial registration

Clinical Research Information Service (CRIS), KCT0001850. Registered on 12 March 2016.
Literature
1.
go back to reference Juch JNS, Mas ET, Ostelo RWJG, et al. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: the mint randomized clinical trials. JAMA. 2017;318(1):68–81.CrossRef Juch JNS, Mas ET, Ostelo RWJG, et al. Effect of radiofrequency denervation on pain intensity among patients with chronic low back pain: the mint randomized clinical trials. JAMA. 2017;318(1):68–81.CrossRef
2.
go back to reference Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74.CrossRef Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014;73(6):968–74.CrossRef
3.
go back to reference Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003;12(2):149–65.PubMedPubMedCentral Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003;12(2):149–65.PubMedPubMedCentral
4.
5.
go back to reference Lee JH, Park HJ, Lee H, et al. Acupuncture for chronic low back pain: protocol for a multicenter, randomized, sham-controlled trial. BMC Musculoskelet Disord. 2010;11:118.CrossRef Lee JH, Park HJ, Lee H, et al. Acupuncture for chronic low back pain: protocol for a multicenter, randomized, sham-controlled trial. BMC Musculoskelet Disord. 2010;11:118.CrossRef
6.
go back to reference Walker J, Mertens UK, Schmidt CO, et al. Effect on healthcare utilization and costs of spinal manual therapy for acute low back pain in routine care: a propensity score matched cohort study. PLoS One. 2017;12(5):e0177255.CrossRef Walker J, Mertens UK, Schmidt CO, et al. Effect on healthcare utilization and costs of spinal manual therapy for acute low back pain in routine care: a propensity score matched cohort study. PLoS One. 2017;12(5):e0177255.CrossRef
7.
go back to reference Rubinstein SM, van Middelkoop M, Assendelft WJJ, et al. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 2011, Issue 2. Art. No.: CD008112. Rubinstein SM, van Middelkoop M, Assendelft WJJ, et al. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 2011, Issue 2. Art. No.: CD008112.
8.
go back to reference Koes BW, van Tulder M, Lin CW, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075–94.CrossRef Koes BW, van Tulder M, Lin CW, et al. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075–94.CrossRef
9.
go back to reference Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478–91.CrossRef Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478–91.CrossRef
10.
go back to reference van Tulder M, Becker A, Bekkering T, et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(Suppl 2):169–91.CrossRef van Tulder M, Becker A, Bekkering T, et al. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(Suppl 2):169–91.CrossRef
11.
go back to reference Park JM, Shin SW, Park JH. A comparative study on the concepts of the Chuna (推拿). J Korean Med Classics. 2008;21(2):173–91. Park JM, Shin SW, Park JH. A comparative study on the concepts of the Chuna (推拿). J Korean Med Classics. 2008;21(2):173–91.
12.
go back to reference Hwang MS, Cho HW, Lee HY, et al. Research trends on Chuna treatment in Korean Medicine: Focused on type of clinical trials, published year, academic journals and treatment technique for each used parts. J Korea Chuna Manual Med Spine Nerves. 2013;8(1)49–61. Hwang MS, Cho HW, Lee HY, et al. Research trends on Chuna treatment in Korean Medicine: Focused on type of clinical trials, published year, academic journals and treatment technique for each used parts. J Korea Chuna Manual Med Spine Nerves. 2013;8(1)49–61.
13.
go back to reference Cho JG, Kim NS, Do SR, et al. National survey on the use of Korean medicine and Korean herbal medicine. Seoul: Korea Ministry of Health and Welfare, Korea Institute for Health and Social Affairs; 2011. 11-1352000-000547-12.1-554. Cho JG, Kim NS, Do SR, et al. National survey on the use of Korean medicine and Korean herbal medicine. Seoul: Korea Ministry of Health and Welfare, Korea Institute for Health and Social Affairs; 2011. 11-1352000-000547-12.1-554.
14.
go back to reference Park J, Kwon SM. Determinants of the utilization of oriental medical services by the elderly. J Korean Oriental Med. 2011;32(1):97–108. Park J, Kwon SM. Determinants of the utilization of oriental medical services by the elderly. J Korean Oriental Med. 2011;32(1):97–108.
15.
go back to reference Ko Y, Lee J, Hwang E, et al. A study to prepare the health insurance coverage for Chuna manual therapy. J Korea Chuna Manual Med Spine Nerves. 2012;7(2):1–14. Ko Y, Lee J, Hwang E, et al. A study to prepare the health insurance coverage for Chuna manual therapy. J Korea Chuna Manual Med Spine Nerves. 2012;7(2):1–14.
16.
go back to reference Boutron I, Altman DG, Moher D, et al. CONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Ann Intern Med. 2017;167(1):40–7.CrossRef Boutron I, Altman DG, Moher D, et al. CONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. Ann Intern Med. 2017;167(1):40–7.CrossRef
17.
go back to reference Shin BC, Kim MR, Cho JH, et al. Comparative effectiveness and cost-effectiveness of Chuna manual therapy versus conventional usual care for nonacute low back pain: study protocol for a pilot multicenter, pragmatic randomized controlled trial (pCRN study). Trials. 2017;18(1):26.CrossRef Shin BC, Kim MR, Cho JH, et al. Comparative effectiveness and cost-effectiveness of Chuna manual therapy versus conventional usual care for nonacute low back pain: study protocol for a pilot multicenter, pragmatic randomized controlled trial (pCRN study). Trials. 2017;18(1):26.CrossRef
18.
go back to reference Kim B, Hwang E, Heo K, et al. The survey on the standardization of Chuna manual technique for operating RCT of non-acute low back pain. J Korea Chuna Manual Med Spine Nerves. 2015;10(2):13–25. Kim B, Hwang E, Heo K, et al. The survey on the standardization of Chuna manual technique for operating RCT of non-acute low back pain. J Korea Chuna Manual Med Spine Nerves. 2015;10(2):13–25.
19.
go back to reference Shin YS, Shin JS, Lee J, et al. A survey among Korea Medicine doctors (KMDs) in Korea on patterns of integrative Korean Medicine practice for lumbar intervertebral disc displacement: preliminary research for clinical practice guidelines. BMC Complement Altern Med. 2015;15(1):432.CrossRef Shin YS, Shin JS, Lee J, et al. A survey among Korea Medicine doctors (KMDs) in Korea on patterns of integrative Korean Medicine practice for lumbar intervertebral disc displacement: preliminary research for clinical practice guidelines. BMC Complement Altern Med. 2015;15(1):432.CrossRef
20.
go back to reference Park JJ, Shin J, Choi Y, et al. Integrative package for low back pain with leg pain in Korea: a prospective cohort study. Complement Ther Med. 2010;18(2):78–86.CrossRef Park JJ, Shin J, Choi Y, et al. Integrative package for low back pain with leg pain in Korea: a prospective cohort study. Complement Ther Med. 2010;18(2):78–86.CrossRef
22.
go back to reference Jeon CH, Kim DJ, Kim SK, et al. Validation in the cross-cultural adaptation of the Korean version of the Oswestry Disability Index. J Korean Med Sci. 2006;21(6):1092–7.CrossRef Jeon CH, Kim DJ, Kim SK, et al. Validation in the cross-cultural adaptation of the Korean version of the Oswestry Disability Index. J Korean Med Sci. 2006;21(6):1092–7.CrossRef
23.
go back to reference Farrar JT, Young JP Jr, LaMoreaux L, et al. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149–58.CrossRef Farrar JT, Young JP Jr, LaMoreaux L, et al. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149–58.CrossRef
24.
go back to reference Kim MH, Cho YS, Uhm WS, et al. Cross-cultural adaptation and validation of the Korean version of the EQ-5D in patients with rheumatic diseases. Qual Life Res. 2005;14(5):1401–6.CrossRef Kim MH, Cho YS, Uhm WS, et al. Cross-cultural adaptation and validation of the Korean version of the EQ-5D in patients with rheumatic diseases. Qual Life Res. 2005;14(5):1401–6.CrossRef
25.
go back to reference Kopec JA, Willison KD. A comparative review of four preference-weighted measures of health-related quality of life. J Clin Epidemiol. 2003;56(4):317–25.CrossRef Kopec JA, Willison KD. A comparative review of four preference-weighted measures of health-related quality of life. J Clin Epidemiol. 2003;56(4):317–25.CrossRef
26.
go back to reference Al Zoubi FM, Preuss RA. Reliability of a measure of total lumbar spine range of motion in individuals with low back pain. J Appl Biomech. 2013;29(6):670–7.CrossRef Al Zoubi FM, Preuss RA. Reliability of a measure of total lumbar spine range of motion in individuals with low back pain. J Appl Biomech. 2013;29(6):670–7.CrossRef
27.
go back to reference Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000;356(9237):1255–9.CrossRef Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet. 2000;356(9237):1255–9.CrossRef
28.
go back to reference Spilker B. Quality of life and pharmacoeconomics in clinical trials. Philadelphia: Lippincott Williams & Wilkins. 1995;1312. Spilker B. Quality of life and pharmacoeconomics in clinical trials. Philadelphia: Lippincott Williams & Wilkins. 1995;1312.
Metadata
Title
Comparative effectiveness of Chuna manual therapy versus conventional usual care for non-acute low back pain: a pilot randomized controlled trial
Authors
Kyeong-Tae Lim
Eui-Hyoung Hwang
Jae-Heung Cho
Jae-Young Jung
Koh-Woon Kim
In-Hyuk Ha
Me-riong Kim
Kibong Nam
Min ho Lee A
Jun-Hwan Lee
Namkwen Kim
Byung-Cheul Shin
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Trials / Issue 1/2019
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-019-3302-y

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