Manual therapy with steroid injections in low-back pain: Improvement of quality of life in a controlled trial with four months' follow-up

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Abstract
Objective - To compare prospectively the effect of manual treatment such as manipulation, specific mobilization, muscle stretching, auto-traction, and cortisone injections with standardized conventional but optimized activating treatment by primary health care teams. Design - Prospective controlled multicentre trial with four months' follow-up. Setting - Kopparberg County, Sweden. Six primary health care or occupational health care centres, representing a catchment area of 56000 residents participated. Participants - 101 outpatients with acute or subacute low-back pain were, during the period February 1988 to April 1989, randomly allocated to one of two treatment groups. Main outcome measure - Quality of life was assessed at baseline and at four months by means of visual analogue scales (VAS). The occurrence of 27 different symptoms of a psychosomatic character was surveyed initially and at four months by questions answered by “yes” or “no” in a questionnaire. Results - There were significant differences concerning quality of life and presence of general symptoms in favour of the group receiving manual treatment with steroid injections. Conclusion - Manual treatment with steroid injections was superior to conventional treatment in minimizing mental and somatic symptoms and increasing quality of life, in parallel with other measures of improvement.