Preliminary investigation of the mechanisms underlying the effects of manipulation: Exploration of a multivariate model including spinal stiffness, multifidus recruitment, and clinical findings

摘要: Study Design.: Prospective case series. Objective.: To examine spinal stiffness in patients with low back pain (LBP) receiving manipulative therapy (SMT), evaluate associations between characteristics and clinical outcome, explore a multivariate model of SMT mechanisms as related to effects on stiffness, lumbar multifidus (LM) recruitment, status prediction rule (CPR) for outcomes. Summary Background Data.: Mechanisms underlying the are poorly understood. Many explanations have been proposed, but few studies potential outcomes or considered multiple concurrently. Methods.: Patients LBP were treated two sessions over 1 week. CPR was assessed at baseline. Clinical outcome based Oswestry disability index (ODI). Mechanized indentation measures ultrasonic LM recruitment taken before after each SMT, Global terminal calculated. Multivariate regression used relationship variables percentage ODI improvement. Zero-order correlations among variables, changes, status, examined. A path analysis effects. Results.: Forty-eight (54% women) had complete data. Significant immediate decreases global occurred post-SMT regardless outcome. improvement greater decrease (P = 0.025), less initial 0.01). supported suggesting that is mediated by improvements stiffness. Initial may relate though their recruitment. Conclusion.: The explaining benefits appear be multifactorial. Both changes play role.