Comparative clinical effects of spinal manipulation, core stability exercise, and supervised exercise on pain intensity, segmental instability, and health-related quality of life among patients with chronic nonspecific low back pain: A randomized control trial

Background: The purpose of this study was to investigate the comparative efficacy of spinal manipulative therapy-high-velocity low-amplitude (SMT-HVLA) thrust, core stability exercise (CSE), and supervised exercise on pain intensity (PI), segmental instability, and quality of life among patients with chronic nonspecific low back pain (CNSLBP). Materials and Methods: This was a randomized controlled trial conducted on 105 patients with CNSLBP (with duration of pain >3 months) distributed in three groups with 35 participants in each group, and an average age of the participants was 25.66 (standard deviation = 6.74) years. Participants received SMT-HVLA thrust (Group 1), CSE (Group 2), and supervised exercise (control group [CG]) with a common ergonomic advice (EA) for 2 weeks. The primary outcomes were PI measured by the Numeric Pain Rating Scale and segmental instability (postural sway) through the center of foot pressure measured by Win-Track platform. The secondary outcome was the quality of life measured by the EuroQoL questionnaire. All outcomes were assessed at baseline and 2 and 4 weeks. Two-way ANOVA followed by with post hoc Tukey's multiple comparison tests was carried out to examine treatment effects, and the relationship between the groups changes across outcome measures. Results: All participants completed the 2 weeks of intervention and the 4 weeks of follow-up. Group 1 had better outcomes than CG at 2 weeks (between-group difference in PI, P = 0.001; segmental instability, P = 0.001, and quality of life, P = 0.001) as compared to Group 2 and CG (between-group difference in PI, P = 0.03; segmental instability, P = 0.04; and quality of life, P = 0.05) as well as at 4 weeks (between-group difference in PI, P = 0.05; segmental instability, P = 0.03; and quality of life, P = 0.04). Conclusions: The SMT-HVLA thrust with EA providing pain reduction in patients with CNSLBP of high severity was associated with clinically better improvement in segmental instability (postural sway) and health-related quality of life. Thus, SMT may be an attractive option in such patients before proceeding for more invasive and costly treatments.