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Randomised controlled trial
Four sessions of spinal manipulation, simple exercises and education are not better than usual care for patients with acute low back pain
  1. Leonardo Oliveira Pena Costa
  1. Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, Brazil
  1. Correspondence to : Leonardo Oliveira Pena Costa, Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno 448, Tatuapé, São Paulo 03071-000, Brazil; lcos3060{at}gmail.com

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Context

Although there is evidence from observational studies that early physiotherapy reduces costs associated with treatment in patients with acute low back pain (LBP), current guidelines do not endorse early physiotherapy for these patients. This randomised controlled trial is the first study aiming to investigate if early physiotherapy is better than usual care for this population.

Methods

This trial recruited 220 adult patients with acute LBP no more than 16 days from the onset of symptoms, without symptoms distal to the knee and with an Oswestry Disability Index score of 20 or higher. Patients with serious spinal pathologies, nerve root compromise, pregnancy and previous lumbar surgery were excluded. A clinical prediction rule was used …

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