{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T22:29:24Z","timestamp":1774564164749,"version":"3.50.1"},"reference-count":41,"publisher":"BMJ","issue":"9","funder":[{"DOI":"10.13039\/501100023490","name":"IMK Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100023490","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100010099","name":"Dansk Kiropraktor Forening","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010099","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006356","name":"Syddansk Universitet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006356","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004825","name":"Nordea-fonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004825","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,8,10]]},"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A substantial number of children experience spinal pain, that is, back and\/or neck pain. Today, no \u2018gold-standard\u2019 treatment for spinal pain in children exists, but manipulative therapy is increasingly being used in spite of a lack of evidence of its effectiveness. This study investigates the effectiveness of adding manipulative therapy to other conservative care for spinal pain in a school-based cohort of Danish children aged 9\u201315 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>The design was a two-arm pragmatic randomised controlled trial, nested in a longitudinal open cohort study in Danish public schools. 238 children from 13 public schools were randomised individually from February 2012 to April 2014. A text message system and clinical examinations were used for data collection. Interventions included either (1) advice, exercises and soft-tissue treatment or (2) advice, exercises and soft-tissue treatment plus manipulative therapy. The primary outcome was number of recurrences of spinal pain. Secondary outcomes were duration of spinal pain, change in pain intensity and Global Perceived Effect.<\/jats:p>\n                    <jats:p>We found no significant difference between groups in the primary outcome (control group median 1 (IQR 1\u20133) and intervention group 2 (IQR 0\u20134), p=0.07). Children in the group receiving manipulative therapy reported a higher Global Perceived Effect: OR 2.22, (95% CI 1.19 to 4.15). No adverse events were reported. Main limitations are the potential discrepancy between parental and child reporting and that the study population may not be comparable to a normal care-seeking population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adding manipulative therapy to other conservative care in school children with spinal pain did not result in fewer recurrent episodes. The choice of treatment\u2014if any\u2014for spinal pain in children therefore relies on personal preferences, and could include conservative care with and without manipulative therapy. Participants in this trial may differ from a normal care-seeking population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT01504698\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\">NCT01504698<\/jats:ext-link>\n                      ; Results.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-021358","type":"journal-article","created":{"date-parts":[[2020,5,7]],"date-time":"2020-05-07T18:08:12Z","timestamp":1588874892000},"page":"e021358","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Conservative care with or without manipulative therapy in the management of back and\/or neck pain in Danish children aged 9\u201315: a randomised controlled trial nested in a school-based cohort"],"prefix":"10.1136","volume":"8","clinical-trial-number":[{"clinical-trial-number":"nct01504698","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0589-0121","authenticated-orcid":false,"given":"Kristina Boe","family":"Dissing","sequence":"first","affiliation":[{"name":"Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Hartvigsen","sequence":"additional","affiliation":[{"name":"Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"},{"name":"Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niels","family":"Wedderkopp","sequence":"additional","affiliation":[{"name":"Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark"},{"name":"Sports Medicine Clinic, Orthopaedic Department Hospital of Lillebaelt, \u00d8stre Hougvej, Middelfart, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lise","family":"Hestb\u00e6k","sequence":"additional","affiliation":[{"name":"Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark"},{"name":"Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,9,10]]},"reference":[{"key":"2025121600271186000_8.9.e021358.1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199801150-00015"},{"key":"2025121600271186000_8.9.e021358.2","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1186\/1471-2474-15-187","article-title":"Spinal pain in adolescents: prevalence, incidence, and course: a school-based two-year prospective cohort study in 1,300 Danes aged 11-13","volume":"15","author":"Aartun","year":"2014","journal-title":"BMC Musculoskelet Disord"},{"key":"2025121600271186000_8.9.e021358.3","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/s12891-017-1424-5","article-title":"Spinal pain in Danish school children \u2013 how often and how long? 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