Results of a study that investigated the comparative effectiveness of early use of thrust manipulation (TM) and nonthrust manipulation (NTM) in patients with mechanical low back pain (LBP) suggest that there is no difference between early use of TM or NTM, and, secondarily, that personal equipoise affects study outcome. Intra-group changes were significant for both groups, say authors and APTA members Chad Cook, PT, PhD, MBA, FAAOMPT, Kenneth Learman, PT, PhD, OCS, COMT, Christopher Showalter, PT, OCS, FAAOMPT, Vincent Kabbaz, PT, and Bryan O'Halloran, PT, OCS, SCS.

For this trial, patients aged 18 and older with mechanically reproducible LBP were randomized into 2 treatment groups. The main outcome measures were the Oswestry Disability Index (ODI) and a Numeric Pain Rating Scale, with secondary measures of rate of recovery, total visits and days in care, and the work subscale of the Fears Avoidance Beliefs Questionnaire work subscale.

A total of 149 subjects completed the trial and received care over an average of 35 days. There were no significant differences between TM and NTM at the second visit follow-up or at discharge with any of the outcomes categories. Personal equipoise was significantly associated with ODI and pain.