The Koes Clinical Trial
OBJECTIVE--To compare the effectiveness of manipulative
therapy, physiotherapy, treatment by the general practitioner, and placebo therapy in patients with persistent
non-specific back and neck complaints.
DESIGN--Randomised clinical trial.
SETTING--Primary health care in the Netherlands.
PATIENTS--256 patients with non-specific back and neck
complaints of at least six weeks' duration who had not received physiotherapy or manipulative therapy in the
past two years.
INTERVENTIONS--At the discretion of the manipulative
therapists, physiotherapists, and general practitioners. Physiotherapy consisted of exercises, massage, and
physical therapy (heat, electrotherapy, ultrasound, shortwave diathermy). Manipulative therapy consisted of
manipulation and mobilisation of the spine. Treatment by general practitioners consisted of drugs (for example,
analgesics), advice about posture, home exercises, and (bed)rest. Placebo treatment consisted of detuned
shortwave diathermy (10 minutes) and detuned ultrasound (10 minutes).
MAIN OUTCOME MEASURES--Changes in severity of the main
complaint and limitation of physical functioning measured on 10 point scales by a blinded research assistant
and global perceived effect measured on a 6 point scale by the patients.
RESULTS--Many patients in the general practitioner and placebo
groups received other treatment during follow up. Improvement in the main complaint was larger with
manipulative therapy (4.5) than with physiotherapy (3.8) after 12 months' follow up (difference 0.9; 95%
confidence interval 0.1 to 1.7). Manipulative therapy also gave larger improvements in physical functioning
(difference 0.6; -0.1 to 1.3). The global perceived effect after six and 12 months' follow up was similar for
both treatments.
CONCLUSIONS--Manipulative therapy and physiotherapy
are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly
better than physiotherapy after 12 months.
To download the full study, click on the link below.
 KOES CLINICAL TRIAL
|