In an accompanying comment, Bart W. Koes, Ph.D., of Erasmus University in Rotterdam, The Netherlands, wrote that some would argue that the type of spinal manipulation used in this study (mainly low-velocity mobilization) is not similar to high-velocity thrust techniques.
said, randomized trials and a subsequent Cochrane review suggest that neither low-velocity nor high-velocity techniques have more favorable results than the other.
Additionally, the treatments used in this study were largely similar to the use of spinal manipulative therapy in common daily practice, Dr. Koes
The important message, he
said, is that the management of acute low-back pain in primary care, namely advice and acetaminophen, is sufficient for most patients.
The trial was funded primarily by Australia's National Health and Medical Research Council
.Diclofenac was donated by Alphapharm. Co-author Richard Day, M.D., noted that he was a member of an advisory board for paracetamol for GlaxoSmithKline but that payments went to an audited hospital account for teaching and research purposes. Dr. Koes
, the comment author, declared no conflicts of interest.