The creation and pilot testing of a method to identify strong and instantaneous responders to spinal manipulation therapy

Reece Granger

Introduction: Spinal manipulative therapy (SMT) can provide pain relief for individuals with non-specific low back pain (NSLBP). Clinical prediction rules can be used to identify patients who are likely to respond positively to a particular treatment approach. A list of 18 signs and symptoms across 5 domains have previously been developed by expert manual therapists, and are suggested to be predictors of instantaneous relief in people with NSLBP after SMT. However, these items have yet to be developed into a workable format and tested in a clinical setting. Objectives: To develop a workable questionnaire and subsequently run a pilot study which tests the feasibility of the study in chiropractic patients with NSLBP, and the preliminary relationships between the 18 signs and symptoms (predictors) and those who have a strong and instantaneous response to SMT. Methods: Practitioner and patient questionnaires were designed based on the previously identified 18 predictors of instantaneous relief following SMT. Ten chiropractors were recruited and were each asked to recruit 10 NSLBP patients from among their normal patients. Each practitioner and patient answered the questionnaires, and feedback from practitioners was sought on the study and questionnaires. Predictors of immediate improvement after SMT were investigated using linear regression. Results: Three validated outcome measures were used in designing the questionnaires and a further nine questions were designed to cover gaps in the literature. Of the 10 chiropractors who agreed to participate, two withdrew and two were lost to follow up. In total there were 63 out of a planned 100 practitioner/patient responses. Three of the five domains had predictors showing statistically significant results for predictive outcomes. These included the patient’s prior response to SMT, the patient’s expected response, Dr’s rating of patient’s health status, Dr’s rating of how well they felt they understood the patient’s goals, and decreased range of motion identified on physical examination. Conclusion: The design of the questionnaire was based on best available evidence-based literature at the time of development. A fully powered study appears to be feasible; however, suggested changes to the questionnaire and data collection process were made. Pilot testing identified multiple possible predictors for instantaneous relief after SMT in chiropractic patients with NSLBP. These results support the need for a fully powered study to further explore the 18 possible predictors of instantaneous relief after SMT.

The creation and pilot testing of a method to identify strong and instantaneous responders to spinal manipulation therapy

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