The effectiveness of manual therapy and proprioceptive neuromuscular facilitation compared with kinesiotherapy in the treatment of low back pain: a four-arm randomized controlled trial.

Low back pain (LBP) cause negative results not only in the physical sphere of patients, but affect their psychic, social and economic spheres. The increasing costs of treatment and health care encourage the search for the most effective methods of treatment.
The aim of the study was to determine whether the use of combined therapy consisting of manual therapy and proprioceptive neuromuscular facilitation (PNF) is more effective than the use of the techniques of manual therapy, PNF or traditional kinesiotherapy as single methods in the treatment of LBP.
A four-arm RCT.
Rehabilitation Department of Hospital in Parczew (Poland).
The study was designed as four-arm randomized comparative controlled RCT and conducted on a group of 200 patients aged 27-55y. (44.9 ± 9.2 years). The patients were randomly divided into four 50-person groups: group A – manual therapy, B – PNF, C – manual therapy and PNF. Group D – traditional kinesiotherapy – control group. Pain intensity was measured using VAS and Laitinen’s questionnaire. Functional disability was assessed using Oswestry Disability Index (ODI) and Back Pain Functional Scale (BPFS).
There was a statistically significant difference in pain reduction (VAS scale) between Group C (4.8 points) and Group D (3.9 points). In all of the groups there was a statistically significant reduction in a degree of disability as measured by the ODI. A level of functional capabilities (BPFS) increased significantly only in Group C (8.8 points) as compared to Group D (5.7 points).
1. All the evaluated methods caused pain reduction which lasted for at least 2 weeks after the end of treatment. 2. The degree of disability as measured by ODI lowered evenly in all groups. 3. Patients’ functional ability assessed with BPFS improved significantly in the group treated with combined therapy (manual therapy and PNF) as compared to the group of traditional kinesiotherapy.
The therapy consisting of manual therapy and the PNF method seems to be more effective than the traditional kinesitherapy in improving functioning of patients with non-specific low back pain.