A Practice-Based Study of Patients with Acute and Chronic Low Back Pain Attending Primary Care and Chiropractic Physicians: Two-Week to 48-Month Follow-Up☆
Abstract
Objective
This study reports pain and disability outcomes up to 4 years for chiropractic and medical patients with low back pain (LBP) and assesses the influence of doctor type and pain duration on clinical outcomes.
Fifty-one chiropractic and 14 general practice community clinics.
Subjects
A total of 2870 acute and chronic ambulatory patients with LBP of mechanical origin.
Methods
Sixty chiropractic (DC) and 111 general practice (MD) physicians participated. Primary outcomes were pain, using a 100-point visual analogue scale (VAS), and functional disability, using the Revised Oswestry Disability Questionnaire. These were measured at baseline and 8 time points. Regression analysis compared acute and chronic DC and MD patients after correcting for baseline differences in the 4 cohorts.
Results
Most improvement was seen by 3 months and sustained for 1 year; exacerbation was seen thereafter. Acute patients demonstrated greater relief at all time points. A clinically important advantage for chiropractic patients was seen in chronic patients in the short-term (>10 VAS points), and both acute and chronic chiropractic patients experienced somewhat greater relief up to 1 year (P< .000). The advantage for DC care was prominent for chronic patients with leg pain below the knee (P< .001). More than 50% of chronic patients had over 50 days of pain in the third year.
Conclusion
Study findings were consistent with systematic reviews of the efficacy of spinal manipulation for pain and disability in acute and chronic LBP. Patient choice and interdisciplinary referral should be prime considerations by physicians, policymakers, and third-party payers in identifying health services for patients with LBP.
aCenter for Outcome Studies, Western States Chiropractic College, Portland, Ore, USA
bDepartment of Family Medicine and Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Ore., USA
cCenter for Health Research, Kaiser Permanente Northwest, Portland, Ore., USA
Mitchell Haas, DC, Center for Outcome Studies, Western States Chiropractic College, 2900 NE 132nd Ave, Portland, OR 97230
☆ Funded by grants from the Health Resources and Services Administration, Department of Health and Human Services (1R18AH10002 and 2R18AH10002), and by a challenge grant from the Foundation for Chiropractic Education and Research (940502), with funds donated by the National Chiropractic Mutual Insurance Corporation. Further support was provided by Western States Chiropractic College.
ABSTRACT