Short or long-term treatment of spinal disability in older adults with manipulation and exercise.

OBJECTIVE: Back and neck pain are associated with disability and loss of independence in older adults. It's unknown whether long-term management using commonly recommended treatments is superior to shorter-term treatment. This randomized clinical trial compared short-term treatment (12 weeks) versus long-term management (36 weeks) of back and neck related disability in older adults using spinal manipulative therapy (SMT) combined with supervised rehabilitative exercises (SRE).

METHODS: Eligible participants were age 65 and older with back and neck disability for more than 12 weeks. Co-primary outcomes were changes in Oswestry and Neck Disability Index after 36 weeks. An intention to treat approach used linear mixed-model analysis to detect between group differences. Secondary analyses included other self-reported outcomes, adverse events and objective functional measures.

RESULTS: 182 participants were randomized. The short-term and long-term groups demonstrated significant improvements in back (-3.9, 95% confidence interval (CI) -5.8 to -2.0 versus -6.3, 95% CI -8.2 to -4.4) and neck disability (-7.3, 95% CI -9.1 to -5.5 versus -9.0, 95% CI = -10.8 to -7.2) after 36 weeks, with no difference between groups (back 2.4, 95% CI -0.3 to 5.1; neck 1.7, 95% CI -0.8 to 4.2). The long-term management group experienced greater improvement in neck pain at week 36, self-efficacy at week 36 and 52, functional ability and balance.

CONCLUSION: For older adults with chronic back and neck disability, extending management with SMT and SRE from 12 to 36 weeks did not result in any additional important reduction in disability. This article is protected by copyright. All rights reserved.