Individualised manual therapy plus guideline-based advice vs advice alone for people with clinical features of lumbar zygapophyseal joint pain: a randomised controlled trial
Abstract
Objectives To determine whether individualised manual therapy plus guideline-based advice results in superior outcomes to advice alone in participants with clinical features potentially indicative of lumbar zygapophyseal joint pain. Design Multi centre parallel group randomised controlled trial. Setting 14 physiotherapy clinics in Melbourne, Australia. Participants Sixty-four participants with clinical features potentially indicative of lumbar zygapophyseal joint pain. Interventions 10-weeks of physiotherapy comprising individualised manual therapy based on pathoanatomical, psychosocial and neurophysiological barriers to recovery plus guideline-based advice (10 sessions) or advice alone (two sessions). Main outcome measures Primary outcomes were activity limitation (Oswestry Disability Index), and separate 0 to 10 numerical rating scales for leg pain and back pain. Measures were taken at baseline and 5, 10, 26 and 52-week. Results Between-group differences for back pain favoured individualised manual therapy over advice for back pain at 5 (1.0; 95% CI 0.6 to 2.0), 10 (1.5; 95% CI 0.5 to 2.4) and 26-weeks (1.4; 95% CI 0.4 to 2.3) as well as for activity limitation at 26 (8.3; 95% CI 2.6 to 14.2) and 52-weeks (8.2; 95% CI 2.3 to 14.2). There were no significant between-group differences for leg pain. Secondary outcomes and responder analyses also favoured individualised manual therapy at almost all time-points. Conclusions In participants with clinical features potentially indi…
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Individualised treatment is more effective than a rigid protocol.
“It has been proven that individualised treatment is more effective than a rigid protocol.15,16”
From Algorithm for Temporomandibular Disorders With Osteopathic Manipulative Therapy: An Expert Consensus (2025) · cites this paper as [15]
Cites
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George, S. Z., Fritz, J. M., Silfies, S. P., Schneider, M. J., Beneciuk, J. M., Lentz, T. A., Gilliam, J. R., Hendren, S., & Norman, K. S. (2021) · Journal of Orthopaedic & Sports Physical Therapy · doi:10.2519/jospt.2021.0304 · Cited by 607 · see citing works
Algorithm for Temporomandibular Disorders With Osteopathic Manipulative Therapy: An Expert Consensus
De-La-Iglesia, L., Bravo, C., Justribó-Manion, C., Montmany, A., Roman-Arias, T., Hue, I., Dugailly, P.-M., Colasanto, S., Van-Caille, P., & Rubí-Carnacea, F. (2025) · Journal of Chiropractic Medicine · doi:10.1016/j.jcm.2025.09.034 · Cited by 1 · see citing works
“15,16 Some protocols already exist in the form of diagnostic and treatment algorithms in manual therapy 17,18 ; however, they are evidence-based protocols, but not agreed upon by experts.”
- Authors
- Ford, J. J., Slater, S. L., Richards, M. C., Surkitt, L. D., Chan, A. Y. P., Taylor, N. F., & Hahne, A. J.
- Affiliations
- La Trobe University (AU)
- Corresponding author
- Ford, Jon J.
- Slater, Sarah L.
- Richards, Matthew C.
- Surkitt, Luke D.
- Chan, Alexander Y.P.
- Taylor, Nicholas F.
- Hahne, Andrew J.
- Venue
- Physiotherapy
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 105
- Issue
- 1
- Pages
- 53-64
- ISSN
- 0031-9406 (ISSN-L)
- OpenAlex
- W2886298278
- Cited by
- 19
- References
- 4
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 2 · 2023: 2 · 2021: 5
- FWCI
- 0.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Physiotherapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Health and Medical Research Council
- La Trobe University
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Keywords
- back pain, activity limitation, Oswestry Disability Index, leg pain, spinal manipulation
- MeSH terms
- Adult, Australia, Combined Modality Therapy, Counseling, Female, Humans, Lumbar Vertebrae, Male, Middle Aged, Single-Blind Method, Range of Motion, Articular, Low Back Pain, Zygapophyseal Joint, Musculoskeletal Manipulations
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