• Menke JM
• Cooper SR
• Pfefer MT

• Association of Chiropractic Colleges / congresses

Methods:This study was reviewed and approved by the Institutional Review Board of Cleveland Chiropractic College, Kansas City. A randomly assigned, two-group design (Activator instrument mechanical force, manually assisted manipulation vs. diversified manipulation) of acute and sub-acute adult low back pain patients was conducted, with patients receiving up to 6 weeks of care. Patients were recruited with complaints of constant or intermittent low back pain that had not lasted more than 16 weeks and patients were required to have a minimum score of 2cm on a 10cm visual analog pain scale. Patients in the instrument adjusting group were assessed by means of the Activator Methods Chiropractic Technique (AMCT) “basic and advanced” protocol and decisions about when and where to adjust were based on these findings, at the discretion of the treating doctor. Patients in the diversified intervention group were evaluated by palpation and radiographic analysis, at the discretion of the treating doctor. Each subject’s overall perception of pain was assessed with a 10cm horizontal visual analog scale (VAS) and functional clinical assessment was evaluated using the revised Oswestry questionnaire.

Results: Forty-two subjects met entrance criteria and were enrolled (21 in each group) in the study during an 18-month period. No adverse events were reported within either group. Three patients dropped out of the study, 1in the Activator group and 2 in the diversified group. Patients were highly satisfied in both treatment groups, although patients in the Activator group rated their treatment as more comfortable than the diversified group. Mean number of treatments was slightly lower in the Activator group compared with the diversified group, but there were no statistically significant differences between groups in end-point outcomes using a t-test.

Discussion: The effects of mechanical force, manually assisted Activator instrument, using Activator Methods Chiropractic Technique protocol appears to be similar to diversified adjustments in patients with acute or sub-acute low back pain. Comparison of two treatment groups, and lack of a control group, limit this study and precludes the ability to discern the contribution of treatments versus the natural history of low back pain. Each of these treatment techniques also has its corresponding system of analysis, and the contribution of the respective analysis methods to treatment outcomes (contribution to clinical knowledge) versus treatment method (efficacy) was not determined here, but is recommended for future study. Insofar as the Activator Methods Chiropractic Technique (AMCT) analysis is integral to the treatment, the contribution of clinical effectiveness due to technique will not be distinguished from the contribution from the analysis. Also, effectiveness or clinical utility of the analysis individually must remain for future investigation.

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