Treatment Effects for Osteopathic Manual Treatment and Ultrasound Therapy in Chronic Low Back Pain
| LBP Reduction Thresholda | OMT RR (95% CI) | UST RR (95% CI) |
|---|---|---|
| Intention-to-treat analysis (N = 455) | ||
| ≥30% | 1.38 (1.16-1.64) | 1.02 (0.86-1.20) |
| ≥50% | 1.41 (1.13-1.76) | 1.09 (0.88-1.35) |
| ≥20 mm | 1.47 (1.17-1.86) | 1.01 (0.80-1.26) |
| ≥40 mm | 1.96 (1.18-3.24) | 1.09 (0.68-1.75) |
| Per-protocol analysis (n = 362) | ||
| ≥30% | 1.42 (1.19-1.70) | 1. 03 (0.87-1.23) |
| ≥50% | 1.48 (1.18-1.86) | 1.11 (0.89-1.38) |
| ≥20 mm | 1.44 (1.13-1.85) | 1.05 (0.83-1.34) |
| ≥40 mm | 2.08 (1.21-3.58) | 1.01 (0.61-1.67) |
| Patients with missed treatments considered nonresponders (N = 455) | ||
| ≥30% | 1.38 (1.13-1.69) | 0.97 (0.80-1.18) |
| ≥50% | 1.43 (1.12-1.83) | 1.05 (0. 82-1.33) |
| ≥20 mm | 1.40 (1.07-1.82) | 0.99 (0.77-1.28) |
| ≥40 mm | 2.01 (1.16-3.49) | 0.95 (0.57-1.59) |
Note: Response ratios are for active vs sham treatments. RR >1 potentially indicates some level of response to active treatment. Using the Cochrane Back Review Group guidelines,33 significant treatment effects are further classified as small, RR <1.25; medium, RR = 1.25 to ≤2.0; or large, RR >2. Thus, table entries for OMT effects were all in the medium to large range. There was no evidence of any treatment effect with UST, as no table entry achieved significance.
IMMPACT = Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials; LBP = low back pain; OMT = osteopathic manual treatment; RR = response ratio; UST = ultrasound therapy.
↵a IMMPACT benchmarks are ≥30% LBP reduction (moderate improvement) and ≥50% LBP reduction (substantial improvement).24 Using absolute pain measures on a 100-mm visual analog scale, benchmarks are ≥20 mm LBP reduction (moderate improvement) and ≥40 mm LBP reduction (substantial improvement).