Verbal framing, rather than measured cognitive-affective variables, is associated with short-term outcomes after spinal manipulation: a secondary analysis of a randomized controlled trial

Pre-treatment communication may influence short-term responses to spinal manipulation. This secondary analysis examined associations between expectations, attitude toward manual therapy, expectation fulfillment, and pain intensity (NPRS-11) and lumbar pressure pain threshold (PPT) across verbal framings. Sixty-six young adults with chronic nonspecific low back pain were randomized to positive, neutral, or negative verbal framing delivered before lumbar spinal manipulation. NPRS-11 and lumbar PPT (L3–L5) were assessed at baseline (t0), immediately post-intervention (t1), and 24 hours post-intervention (t2). Group-specific correlation analyses and multiple linear regression were performed. Associations were sparse and inconsistent. Expectation fulfillment assessed at t2 showed no consistent associations with NPRS-11 or PPT at t1 or t2. In the positive group, higher expectations correlated with higher immediate PPT at t1 L4 (r = 0.47) and L5 (r = 0.43), and a more favorable attitude correlated with lower NPRS-11 at t2 (r = −0.45). In regression analysis predicting NPRS-11 at t2, only verbal framing group was retained (adjusted R2 = 0.26; p Short-term NPRS-11 and lumbar PPT were associated with verbal framing rather than with cognitive-affective variables. The ClinicalTrial.gov identifier is NCT06537739. We looked again at data from a study in young adults with long-lasting low back pain with no clear cause. Everyone received the same hands-on treatment to the lower back (spinal manipulation). Before treatment, people were randomly assigned to hear one of three short messages: positive, neutral, or negative. We asked whether three things were linked to results 24 hours later: what people expected before treatment, how they felt about hands-on therapy in general, and whether they thought the treatment met their expectations. We compared these factors with two short-term outcomes: how much pain people reported and how sensitive they were to pressure. Overall, expectations, attitude, and feeling that expectations were met were not clearly linked to pain or pressure sensitivity. When we tested what best explained pain after 24 hours, the type of message said before treatment was the only factor that helped explain differences in pain. The other factors did not add useful information. In this group, short-term pain changes seemed to depend more on what was said just before treatment than on what people believed beforehand.