I recently had the opportunity to participate in a RCT to collect data to deterimine if within and between-session changes of pain and disability are associated with overall outcomes, pain and self-reported recovery in patients with mechanical, nonspecific LBP who are treated with manual therapy.
The study involved 100 subjects who demonstrated a positive response to manual therapy during the initial assessment (ie. had a positive change in symptoms following a mobilization). This group was then randomized to recieve either a thrust or non-thrust manipulation and outcomes of the numeric pain rating scale, Oswestry and self-report of recovery (0-100%) were taken. Outcomes were measured at initial evaluation, second visit and discharge.
The results indicated that a there was a significant association of a within- and between session change at the second physical therapy visit and discharge outcomes for pain and disability. The type of manual intervetion applied did not matter. Simply a positive response to an initial session involving manual therapy was predictive of outcomes . This is the first study to show an association between these variables and is the first to define the extent of change necessary for prognosis of an outcome.
Check it out:
Cook CE, Showalter C, et al. Can a within/between-session change in pain during reassessment predict outcome using a manual therapy intervention in patients with mechanical low back pain?Manual Therapy (2012), doi:10.1016/j.math.2012.02.020