Comfort during side posture lumbopelvic manipulation in a low back pain population—effects of a typical versus modified flexed lumbopelvic position: a crossover randomized control trial
Bibliographic record
Abstract
BACKGROUND: Literature on low back pain (LBP) treatment suggests not all LBP is the same and patients with extension- or flexion-related LBP may benefit from different strategies. This study's objective was to evaluate the effect of participant positioning when delivering spinal manipulation on reported immediate comfort, in individuals with LBP. METHODS: This a randomized crossover trial. Volunteer adult participants with LBP were recruited from a chiropractic college campus clinic to receive two procedures in random order: 1. Standard side posture lumbopelvic manipulation (SPLM) and 2. Modified flexed lumbopelvic manipulation. The modified position was similar to the standard, but with increased hip and lumbopelvic flexion. Participants were not blinded. The primary outcome of self-reported comfort was recorded using a 0-10 scale. Paired t-tests were used to compare mean comfort scores, and a minimal clinically important difference of 2.0 was used. Secondary analysis examined correlations between comfort during active range of motion (AROM) and the two SPLM procedures. An exploratory analysis comparing within-participant differences was examined. All reported harms were mild in nature (e.g. discomfort). RESULTS: Forty participants were recruited (mean 25.5 years of age, 75% female). 20 participants started with the Standard SPLM and 20 started with the Modified Flexed SPLM. No differences in comfort were found between the Standard SPLM (N = 40) versus Modified flexed SPLM (N = 40), (mean (SD) = - 0.01 (2.3), Effect Size Cohen's d = - 0.004 95% CI (- 0.32, 0.32)). No correlations were found between the comfort during AROM and the two SPLM procedures. Observing within-participant differences for individual comfort, 14 participants had a clinically significant difference ≥ 2. Specifically, 6 participants had lower scores with Standard SPLM and 8 participants had lower scores with Modified flexed SPLM. CONCLUSION: Comparing comfort during a Modified flexed SPLM to the Standard one revealed no difference for a population with LBP. However, some individuals did demonstrate a comfort preference for a Standard versus a Modified flexed position. Future studies should examine other variations of manipulation and particular subgroups of individuals with LBP (e.g. direction related) that experience discomfort during manipulation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".