Table 1 The study treatment programs
Intervention | Home Exercise Program (HEP) | Supervised Exercise Program (SEP) + HEP | Spinal Manipulative Therapy (SMT) + HEP |
|---|---|---|---|
Components | Information and instructions for self-care for pain (postural adjustments during activities of daily living; use of ice, heat, medications; importance of movement and staying active). Instructions in low load exercises with graded progressions, to be done at home to improve balance and coordination, trunk strength and endurance. Stretching exercises (seated or standing lumbar flexion, full spine flexion/extension motion cycles, quadriceps stretch, hamstring stretch, hip stretch, head retraction, and chest expansion). Muscle strength and endurance exercises: chair squats, abdominal curls, seated back extension (isometric or using resistance tubing), seated upright rows (using resistance tubing), and push-ups. Balance exercises: standing knee lifts, standing straight-leg hip flexion and extension. | Information and instructions for self-care for pain (postural adjustments during activities of daily living; use of ice, heat, medications; importance of movement and staying active). Light aerobic warm up on stationary equipment. Instructions, monitoring and encouragement in low load exercise with graded progressions, with an emphasis on high repetitions (up to 20) to increase endurance, strength and balance. Stretching, strength and balance exercises as described for HEP, with the addition of neck flexion, quadruped, lunges, side bridging, and trunk extension exercises on an adjustable angle roman chair. | Manual treatment based on physical condition and tolerance. Up to 4 min of adjunct therapies to facilitate SMT (light soft tissue massage, active and passive stretching, ischemic compression of tender points, ice and heat). High velocity, low amplitude SMT when possible. Other manual therapies if needed (low velocity, low amplitude SMT or mobilization, flexion-distraction manipulation, drop-table assisted SMT. |
Design & delivery format | Tailored to individual ability. Individualized guidance by exercise therapists who closely monitored form, modified exercises, prescribed progressions, and provided encouragement. Binder with pain management tips, illustrated instructions and simple diary to record performance of exercise at home. | Tailored to individual ability. Individualized guidance by exercise therapists who closely monitored form, modified exercises, prescribed progressions, and provided encouragement. Binder with illustrated descriptions, simple diary to record performance of exercise at home. | Individualized: number of visits, spinal levels treated, SMT and manual therapy technique used and adjunct therapies determined by provider according to patient needs and tolerance. |
Delivery method | One-on-one, in person --therapist lead | One-on-one, in person ----therapist lead | One-on-one, in person Licensed chiropractor |
Dose | • 4 sessions • 45–60 min per session • Maximum frequency: 1 times/week | • 20 sessions • 60 min per session • Maximum frequency: 1 times/week | • Up to 20 sessions (based on discretion of provider and patient preferences) • 10 to 20 min per session • Maximum frequency: 2 times/week |