Manual Therapy

Background: Patient perceptions may influence the effectiveness and utilization of healthcare interventions, particularly for complex health conditions such as sciatica or back-related leg pain (BRLP).

Objectives: To explore BRLP patients' perceptions of spinal manipulative therapy (SMT) and home exercise with advice (HEA).

Design: Qualitative study in a controlled clinical trial.

Method: Semi-structured interviews conducted after 12 weeks of treatment asked participants about
satisfaction with care and whether treatment was worthwhile. An interdisciplinary research team
conducted content analysis using qualitative data analysis software to identify and summarize themes.

Results: Of 192 trial participants, 174 (91%) completed interviews (66% female, age 57.0 ± 11.5 years).
Participants identified interactions with providers and staff, perceived treatment effects, and information
as key contributors to both their satisfaction and the worthwhile nature of treatment. HEA was liked for
its convenience and ability to foster an exercise habit. SMT was liked for specific aspects of the modality
(e.g. manipulation, stretching) and provider competency. Most participants reported no dislikes for SMT
or HEA, but some noted the dose/time commitment for SMT and discipline of HEA as least liked aspects
of the interventions.

Conclusions: The quality of patient-provider interactions, perceived treatment effects, and information
sharing influenced BRLP patients' satisfaction with care. Qualitative research describing patients' preferences can facilitate translation of study findings into practice and allow clinicians to tailor treatments
to facilitate compliance and satisfaction with care.

Spinal manipulative therapy (SMT) and exercise have demonstrated effectiveness for neck pain (NP). Adverse events (AE) reporting in trials, particularly among elderly participants, is inconsistent and challenges informed clinical decision making.

This paper provides a detailed report of AE experienced by elderly participants in a randomized comparative effectiveness trial of SMT and exercise for chronic NP.

AE data, consistent with CONSORT recommendations, were collected on elderly participants who received 12 weeks of SMT with home exercise, supervised plus home exercise, or home exercise alone. Standardized questions were asked at each treatment; participants were additionally encouraged to report AE as they occurred. Qualitative interviews documented participants' experiences with AE. Descriptive statistics and content analysis were used to categorize and report these data.

Compliance was high among the 241 randomized participants. Non-serious AE were reported by 130/194 participants. AE were reported by three times as many participants in supervised plus home exercise, and nearly twice as many as in SMT with home exercise, as in home exercise alone. The majority of AE were musculoskeletal in nature; several participants associated AE with specific exercises. One incapacitating AE occurred when a participant fell during supervised exercise session and fractured their arm. One serious adverse event of unknown relationship occurred to an individual who died from an aneurysm while at home. Eight serious, non-related AE also occurred.

Musculoskeletal AE were common among elderly participants receiving SMT and exercise interventions for NP. As such, they should be expected and discussed when developing care plans.