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Naprapathic manual therapy: an option for back and neck pain

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Naprapathic manual therapy: an option for back and neck pain

Vol: 2| Issue: 5| Number:44| ISSN#: 2564-2537
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A

The long-term effects of naprapathic manual therapy on back and neck pain - results from a pragmatic randomized controlled trial

BMC Musculoskelet Disord. 2010 Feb 5;11:26

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409 patients with non-specific pain/disability in the back and/or neck were randomized to be managed with either naprapthic manual therapy or by evidence based advice only. In the long term (56 weeks), naprapathic manual therapy produced greater improvement in pain and disability compared to advice from a physician on staying active and coping with pain.

Publication Funding Details +
Non-Industry funded
the Ekhagastiftelsen, the Swedish Research Council, the Stockholm County Council, the Uppsala County Council, Capio (626), the Swedish Naprapathic Association, the Health Care Science Post-Graduate School and The Centre for Health Care Science at the Karolinska Institutet

Risk of Bias


Reporting Criteria


Fragility Index


Was the allocation sequence adequately generated?

Was allocation adequately concealed?

Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?

Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?

Blinding Patients: Was knowledge of the allocated interventions adequately prevented?

Was loss to follow-up (missing outcome data) infrequent?

Are reports of the study free of suggestion of selective outcome reporting?

Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?

Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?

Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?

Yes = 1

Uncertain = 0.5

Not Relevant = 0

No = 0

The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.




Outcome Measurements


Inclusion / Exclusion


Therapy Description



Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65

The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.

Why was this study needed now?

Back and neck pain are common clinical problems, yet the evidence of effectiveness of treatments in the long-term is sparse. Previously, naprapathic manual therapy has been shown to be effective in the short term. This study aimed to observe the long-term effectiveness of naprapathic manual therapy for back and neck pain.

What was the principal research question?

Is naprapathic manual therapy better than an evidence-based advice for management of pain intensity, disability and health status, in patients with non-specific pain/disability in the back and/or neck?

Study Characteristics -
409 patients (mean age 47 yr) with non-specific pain/disability in the back and/or neck
Naprapathic Manual Therapy: Patients were treated with naprapathic manual therapy, composed of spinal manipulation/mobilization, massage therapy and stretching. Patients were also given advice on preventing recurrent pain and disability through physical activity and ergonomics. Six sessions were conducted within 6 weeks, each lasting approximately 45 minutes (Mean age: 46; n=206).
Control group: Patients were given evidence-based advice to stay active and strategies of coping with pain. Booklets were also handed out, detailing information and exercises for back and neck pain. Advice was given following medical examination at the study center (approximately 15 minutes) (Mean age: 48; n=203).
Primary Outcome Measure: Pain intensity and disability measured by Chronic Pain Questionnaire and modified Whiplash Disability Questionnaire (WDQ) Secondary Outcome Measure: Health status measured by SF36 questionnaire and perceived recovery
Prospective, Single-center, RCT
26 and 52 week follow up

What were the important findings?

  • More participants in the naprapathic manual therapy group achieved a clinically-important improvement in pain intensity and disability at 26 and 52 weeks follow-up.
  • The naprapathy group did better in terms of improvement in pain (p=0.002), disability on CPQ score (p=0.005), and disability on WDQ score (p<0.001) at one year follow-up.
  • Health-related quality of life questionnaire showed a better result in the naprapathic manual therapy group at both 26 and 52 weeks follow-up, in terms of bodily pain and social function. In other aspects, however, there was no statistical difference between the groups.

What should I remember most?

For patients with non-specific back and/or neck pain, naprapathic manual therapy produced a greater improvement in pain and disability, compared to an evidence-based advice provided by a physician in the form of staying active and on how to cope with pain. Since naprapathy has previously been shown to be effective in the short term, naprapathy can now be considered to be effective in both the short and long term.

How will this affect the care of my patients?

Naprapathic manual therapy, having demonstrable efficacy in improving pain and disability in patients with nonspecific back or neck pain, is an effective alternative for consideration when deciding upon the best option in a mix of manual therapies in primary care for these patients.

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