In 1993, Koes, et. al., conducted a randomized clinical trial in primary health care settings in the Netherlands, researchers aimed to assess the effectiveness of manual therapy and physiotherapy in subgroups of patients with persistent back and neck complaints. Additionally, the study sought to explore the correlation between three crucial outcome measures employed in the trial.

The study enrolled 256 patients experiencing nonspecific back and neck complaints lasting at least 6 weeks, who had not received physiotherapy or manual therapy in the past 2 years. Interventions were administered based on the discretion of manual therapists, physiotherapists, and general practitioners. Physiotherapy involved exercises, massage, and various physical therapy modalities, while manual therapy comprised manipulation and mobilization of the spine. General practitioners provided treatment through drugs, posture advice, home exercises, and (bed)rest. Placebo treatment involved detuned shortwave diathermy and ultrasound.

The primary outcome measures included changes in the severity of the main complaint and limitations in physical functioning, both measured on 10-point scales by a blinded research assistant. The global perceived effect was also assessed on a 6-point scale by the patients.

For patients with chronic conditions (complaint duration of 1 year or longer), manual therapy demonstrated a larger improvement in the main complaint (4.3) compared to physiotherapy (2.5). Similarly, in patients under 40 years old, manual therapy yielded a greater improvement in the main complaint (5.5) compared to physiotherapy (4.0) at the 12-month follow-up. The labeling of patients as “suitable” or “not suitable” for manual therapy did not predict outcome differences. Overall, a moderate to strong correlation was observed between the three outcome measures. However, a noteworthy number of patients reported a relatively low perceived benefit, despite receiving high scores for improvement in the main complaint and physical functioning from the research assistant.

The subgroup analysis suggests that manual therapy may result in superior outcomes compared to physiotherapy, particularly in chronic patients (complaint duration of 1 year or longer) and those younger than 40 years old. However, differences in other subgroups were less distinct. These exploratory findings warrant further investigation in future research to establish their robustness and generalizability.

Reference: Koes, B. W., Bouter, L. M., Van Mameren, H., Essers, A. H., Verstegen, G. J., Hofhuizen, D. M., & Knipschild, P. G. (1993). A randomized clinical trial of manual therapy and physiotherapy for persistent back and neck complaints: subgroup analysis and relationship between outcome measures. Journal of Manipulative and Physiological Therapeutics, 16(4), 211-219.