Naprapathic manual therapy and other factors of importance for the prognosis of neck and back ain

Abstract: Introduction: Neck and back pain common health problems causing economic burden and individual suffering worldwide. Aim: The overall aim of this thesis was to increase understanding of naprapathic manual therapy and other factors of potential importance for the prognosis of back and neck pain. Specific aims: Study I: 1) to assess and compare the sex-specific recovery from spinal pain and psychological distress as single and comorbid conditions, 2) to describe the interrelationships between these conditions at baseline and at follow-up and 3) to explore whether spinal pain is a risk factor for onset of psychological distress and vice versa. Study II: to explore the role of the role of good sleep on the prognosis of non-specific neck and/or low back pain. Studies III and IV: to compare the occurrence and severity of adverse events (study III) and the treatment effect (study IV) of naprapathic manual therapy between different treatment technique combinations as part of naprapathic manual therapy. Methods: Study I: a cohort study based on The Stockholm Public Health Cohort including 23,794 participants. A random sample of the population in Stockholm was approached with postal questionnaires at baseline and at follow-up five years later. Study II: a cohort study that was a secondary analysis of data from a randomized controlled trial. Information was used from baseline and follow-up questionnaires at 12 and 52 weeks. Studies III and IV: a randomized controlled trial. Participants were recruited among patients, ages 18–65 years, seeking care for neck and/or back pain. Participants were randomly assigned to one of three treatment arms: 1) naprapathic manual therapy (i.e. spinal manipulation, spinal mobilization, stretching and massage), 2) naprapathic manual therapy excluding spinal manipulation or 3) naprapathic manual therapy excluding stretching. Treatments were provided by students in the seventh semester of a total of eight. Results: Study I: comorbidity of spinal pain and psychological distress was twice as common among women as among men. Recovery was less likely with comorbidity than with single conditions of spinal pain or psychological distress. Overall, 24% of women and 17% of men with spinal pain without psychological distress at baseline had psychological distress at follow-up. The corresponding figures for spinal pain among participants with psychological distress without spinal pain at baseline were 24% and 20%. Spinal pain was a determinant of psychological distress and vice versa. Study II: patients with good sleep at baseline were more likely to experience a clinically important improvement in pain and pain-related disability compared to patients with impaired sleep at the 1-year follow-up. Study III: adverse events after combined manual therapy were common and mostly mild and transient. The most common adverse events were muscle soreness, increased pain and stiffness. No differences were found between the treatment arms. Women more often had short and long moderate adverse events compared to men. Study IV: There were no disparities between the treatment arms in clinically important improvement in pain or pain-related disability after 1 year of follow-up, in men or in women. Conclusion: Spinal pain with psychological distress is common, especially among women. Comorbidity of neck and/or back pain and psychological distress had a negative effect on the prognosis of these conditions. Good sleep had a positive effect on the prognosis of non-specific neck and/or back pain. Adverse events after manual therapy were common and transient. There were no differences in the occurrence of adverse events or in treatment effects when either spinal manipulation or stretching was excluded from the treatment arsenal of combined manual therapy for non-specific neck and/or back pain.