Conservative care with or without manipulative therapy in the management of spinal pain in Danish children aged 9-15. A randomized controlled trial

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Today, no ‘gold standard’ treatment for spinal pain in children exists, but manipulative therapy (MT) is widely used, both alone and in combination with other types of therapy such as exercise and soft tissue treatment, in spite of lack of evidence for effectiveness in children. The use of MT on children is mostly based on clinical experience as well as knowledge from guidelines for adults. Thus, it appears essential to investigate the effect on children of this widely used treatment and thereby gain more solid evidence about management of children with spinal pain. Although spinal pain is transient and trivial for most children, some are severely affected with recurrent and bothersome complaints. Therefore, it is of great importance to focus on approaches to diminish the amount of recurrent events of spinal pain and the potential long-term effects. In this trial we investigated the effect of MT on the course of spinal pain in children in addition to other conservative care applied in a school-based cohort.
The study is a randomized controlled trial (RCT) nested in a longitudinal population-based open cohort study (CHAMPS Study-DK). Data collection included text messages (SMS) reported by the parents as well as clinician generated data from examinations. Intervention consisted of 1) soft tissue treatment, exercise and advice or 2) soft tissue treatment, exercise and advice, plus MT. The children were followed from February 2012 to June 2014 with various follow-ups depending on inclusion date. Primary outcome was number of recurrences of spinal pain during the follow-up period. Secondary outcomes were total duration of spinal pain in the follow up period, average duration of each pain episode, Global Perceived Effect (GPE) and change of pain intensity at week two, measured on a Numerical rating Scale (NRS). Mixed effects regression models were used to assess the effect of manipulative therapy on all outcomes.
238 children aged 9 to 15 were included in the two-arm RCT. There was no statistically significant difference between groups in relation to number of recurrences (IRR 1.25; 95% CI 0.98-1.60), average episode length (β=0.12; 95% CI -0.02-0.26), total number of pain weeks (IRR 1.18; 95% CI 0.93-1.52) or change in NRS (β=0.10; 95% CI -0.57-0.78). However, the children in the MT group had a statistically significantly better outcome on GPE (OR 2.16; 95% CI 1.07-3.79).
Discussion and conclusions
The effect of manipulative therapy on children with spinal pain is still not clearly elucidated, but this study provides a foundation for further research in this area. The population retrieved from schools might not be comparable to normal clinical populations and therefore the results might not be directly transferrable. Furthermore, the outcome measures used in this study are debatable, and the choice of outcome for defining improvement in this age group needs exploration. We believe that more qualitative approaches could be beneficial to qualify future trials.
Original languageEnglish
Publication date22. Mar 2017
Publication statusPublished - 22. Mar 2017
Event2017 International Back and Neck Pain Research Forum - Oslo, Norway
Duration: 12. Sep 201715. Sep 2017


Conference2017 International Back and Neck Pain Research Forum
Internet address

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