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Background  Back and neck pain are very common, disabling and recurrent disorders in the general population and the knowledge of long-term effect of treatments are sparse. The aim of this study was to compare the long-term effects (up to one year) of naprapathic manual therapy and evidence-based advice on staying active regarding non-specific back and/or neck pain. Naprapathy, a health profession mainly practiced in Sweden, Finland, Norway and in the USA, is characterized by a combination of manual musculoskeletal manipulations, aiming to decrease pain and disability in the neuromusculoskeletal system.    Methods  Subjects with non-specific pain/disability in the back and/or neck lasting for at least two weeks (n = 409), recruited at public companies in Sweden, were included in this pragmatic randomized controlled trial. The two interventions compared were naprapathic manual therapy such as spinal manipulation/mobilization, massage and stretching, ( Index Group ), and advice to stay active and on how to cope with pain, provided by a physician (C ontrol Group ). Pain intensity, disability and health status were measured by questionnaires.    Results  89% completed the 26-week follow-up and 85% the 52-week follow-up. A higher proportion in the Index Group had a clinically important decrease in pain (risk difference (RD) = 21%,  95% CI: 10-30 ) and disability (RD = 11%,  95% CI: 4-22 ) at 26-week, as well as at 52-week follow-ups (pain: RD = 17%,  95% CI: 7-27  and disability: RD = 17%,  95% CI: 5-28 ). The differences between the groups in pain and disability considered over one year were statistically significant favoring naprapathy (p ≤ 0.005). There were also significant differences in improvement in bodily pain and social function (subscales of SF-36 health status) favoring the Index Group.    Conclusions  Combined manual therapy, like naprapathy, is effective in the short and in the long term, and might be considered for patients with non-specific back and/or neck pain.    Trial registration  Current Controlled Trials ISRCTN56954776.

The long-term effects of naprapathic manual therapy on back and neck pain - Results from a pragmatic randomized controlled trial