Effectiveness of acupuncture and manipulation in the management of individuals with sacroiliac joint disorders based on clinical prediction rules

Background: Despite being identified as a serious health concern, effective means of managing chronic LBP with SIJ disorders based on sound evidence still remains controversial. Aims: The purpose of this study is to compare the effects of combined treatment (acupuncture, manipulative therapy, AMG) with manipulative therapy (MTG) and standard physiotherapy (STG) alone based on Flyn et al.'s clinical prediction rule (CPR). Methods: Eighty-one participants with disorders of lower back pain and Sacroiliac joint (SIJ) were randomised into the 3 treatment groups. Outcome measures of pain intensity, functional disability and quality of life were carried out at baseline, after 6 weeks of treatment and at 3-month follow up. Participants were treated according to the treatment in the group to which they are randomised. Results: Participants in the AMG showed grater improvement than the others after six weeks of treatment. Paired t – test showed significant difference (t = 3.142, P = 0.004) in the mean percentage improvement between those who met the CPR (64.39 (13.0)) and those who did not (49.44 (7.89)). In the AMG, 21 (77.8%) participants recorded treatment success while 6 (22.2%) recorded treatment failure. One of the hip having more than 350 of internal rotation showed significant predictive value in association with treatment success (Wald test score = 37.887, P = 0.035 with an odd ratio value of 0.857). Conclusion: A combined treatment consisting of acupuncture, manipulative therapy and exercises will offer greater benefits to patients with lower back pain and SIJ disorders. The presence of at least 35 degrees of internal rotation in one of the hip joint is predictive factor of treatment success with manipulative therapy and acupuncture in patient with lower back and SIJ disorders.