Author Names
Oguz Dayanir, I., Birinci, T., Kaya Mutlu, E., Ali Akcetin, M., & Osman Akdemir, A.
Reviewer Name
Madeline Koontz, SPT
Reviewer Affiliation(s)
Duke Doctor of Physical Therapy Division
Paper Abstract
Objectives: This pilot study aimed to compare the efficacy of manual pressure release (MPR), strain counterstrain (SCS), and integrated neuromuscular inhibition technique (INIT) in the management of chronic nonspecific low back pain (LBP). Design: Single-blind, randomized, controlled pilot trial. Setting: Neurosurgery clinic. Subjects: Forty-eight patients (46 women; mean age, 35.47 ± 10.58 years) diagnosed chronic nonspecific LBP and who had at least one active myofascial trigger point (MTrP) in the quadratus lumborum, iliocostalis lumborum, gluteus maximus, gluteus medius, and gluteus minimus muscles were included. Interventions: Patients received a standard home exercise program in addition to the MPR technique (MPR group), SCS technique (SCS group), and INIT (INIT group) for 12 sessions (2 days/week for 6 weeks). Outcome measures: The primary outcome was the visual analog scale (VAS). The secondary outcomes were MTrP examination, pressure pain threshold, lumbar active range of motion, Oswestry Disability Index (ODI), Beck depression inventory, and state-trait anxiety inventory. Results: There is no significant difference in terms of the percentage of deactivated MTrPs after 1st session and 12th session between groups (p > 0.05), but the percentage of deactivated MTrPs was less in MPR group than other groups. The overall group-by-time interaction for the repeated measures analysis of variance was not significant for primary and secondary outcomes (p > 0.05), but the improvement in the VAS-activity and the ODI was slightly better in the SCS group compared with other groups. Conclusions: These preliminary findings, which might help provide a glimpse into the clinical effectiveness of three manual therapy techniques (MPR, SCS, and INIT) rather than statistical significance, indicated that SCS or INIT might provide slightly better improvement in pain during activity, deactivation of MTrPs, and disability related to pain in chronic nonspecific LBP.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT?
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- No
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- Yes
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Yes
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Cannot Determine, Not Reported, or Not Applicable
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- No
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
After a six-week intervention, similar improvements in active range of motion, depression, anxiety, pain-related disability, pain intensity, and pressure pain threshold were found between the three groups. Therefore, no single manual therapy technique stands out in this regard.
Key Finding #2
Improvement on the visual analog scale during activity was greater in the SCS group than the other two groups. Although no significant difference between the three techniques in other areas, the SCS technique may reduce pain with movement more than the MPR and INIT techniques.
Key Finding #3
More trigger points were deactivated in the groups receiving SCS and INIT techniques than in the group receiving the MPR technique, which may lead to less pain later on.
Please provide your summary of the paper
This study compares the effects of three different manual therapy techniques combined with a home exercise program on chronic pain levels. It found similar beneficial results in all three treatment groups. However, reduction in pain during activity was greatest in the group receiving SCS.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
While many other studies compare manual therapy as a whole to other treatments, this study stands out as it aims to determine the most effective manual therapy technique on pain reduction. This information is important for clinicians to know, as these techniques are powerful tools when used appropriately. If a patient is experiencing frequent pain with activity, the clinician may consider using the SCS technique. This study contains limitations. It did not include a group that participated in a home exercise program without any manual therapy treatment, which would have been useful to see as a comparison to the three manual therapy technique groups. The relatively small sample size of 46 participants is a limitation in broadly applying the results of this study. Additionally, it would be beneficial to see a gender comparison in the future, as this study used only female participants.
