REPERCUSSÕES DA MANIPULAÇÃO VERTEBRAL NOS DESFECHOS NEUROFISIOLÓGICOS E NEUROMUSCULARES EM PACIENTES COM DOR LOMBAR CRÔNICA ESTRATIFICADOS PELO RISCO DE MAU PROGNÓSTICO: ENSAIO CLÍNICO ALEATORIZADO

Abstract

: Chronic low back pain (CLBP) is a painful experience influenced by various factors, including psychosocial ones. Risk stratification for poor prognosis for pain, which has a biopsychosocial basis, is a way of better understanding the physical-functional repercussions induced by CLBP, as well as the responses to interventions. One intervention frequently used to treat CLBP is spinal manipulation (VM), the effects of which can, at least theoretically, be explained by changes in the autonomic nervous system (ANS) and neuromuscular system. Objective: To explore the effects of VM on neurophysiological (heart rate variability) and neuromuscular (proprioception and strength) outcomes in volunteers with chronic low back pain stratified by risk of poor prognosis. Methods: This is a blinded randomized clinical trial in which volunteers with CLBP were divided into 2 intervention groups, a placebo group (PG) and a group that received VM (GM). Each group was further subdivided into strata according to the risk of developing poor prognosis by the Start Back Screening Tool into 3 subgroups, low (LR), medium (MR) and high (HR) risk of poor prognosis for pain. Data was collected to assess the ANS using heart rate variability (HRV), trunk proprioception and trunk extensor strength using a traction dynamometer. The outcomes were assessed at four different times: i) before and ii) immediately after the procedure, iii) 24 hours and iv) 7 days after the intervention. The statistical test used was the generalized mixed model (GMM), with emphasis on the main effects for the factors intervention and time of evaluation; after this analysis, the need to test the factor related to risk stratum was evaluated. Results: 42 volunteers were assessed (GM/n=22; GP/n=20). No significant effects of VM on HRV parameters were observed. Neuromuscular outcomes, on the other hand, underwent significant changes as a result of the manipulation for maximum isometric strength (MIF) and proprioception. Conclusion: Our findings suggest that VM does not affect neurophysiological outcomes in patients with CLBP, but it does impact neuromuscular outcomes such as MIF and proprioceptive acuity. manipulation.