The Nordic Back Pain Subpopulation Program: A 1-Year Prospective Multicenter Study of Outcomes of Persistent Low-Back Pain in Chiropractic Patients
Objectives
The aims of the study are to describe the low-back pain and disability status at baseline, the fourth visit, and at 3 and 12 months in Norwegian patients treated by chiropractors for persistent low back pain (LBP) and to describe movements between various subgroups over time.
Design
Prospective uncontrolled multicenter study.
Methods
Self-reported pain was measured with a 0-10 box scale and disability with the revised Oswestry LBP questionnaire. The main outcome measures were mean pain or disability values and numbers of LBP-free patients. LBP status was assessed through patient questionnaires at baseline, the fourth visit, and after 3 and 12 months.
Study Subjects and Setting
Of 205 invited chiropractors, 115 Norwegian chiropractors were each willing to recruit 10 consecutive patients who had LBP for at least 2 weeks at the time of consultation and a minimum of 30 days altogether within the preceding year. The numbers of participants were 875 (baseline), 799 (fourth visit), 598 (3 months), and 512 (12 months).
Results
Considerable improvement was noted between baseline and the fourth visit both for mean values and in numbers of LBP-free patients. There was virtually no further mean improvement up to the third month, whereas the number of LBP-free individuals doubled. At 12 months, no additional improvement was noted, and 80% reported that they had experienced recurrent problems. Less than 1% reported considerable worsening. Severity of symptoms at baseline determined the subsequent outcome, mild symptoms tending to worsen, and severe symptoms tending to improve.
Conclusion
The outcome pattern is similar to that found in other clinical studies. Treatment outcome should be measured early with follow-up at 3 rather than at 12 months, because patients will improve or recover quickly but may experience recurring problems. Numbers “cured” appear to be a feasible outcome variable in this type of study population.
aResearch Professor, Medical Research Unit in Ringkøbing County, Ringkøbing, Denmark
bPrivate practice, Norwegian Institute for Chiropractic Research, Oslo, Norway
cResearcher, Medical Research Unit in Ringkøbing County, Ringkøbing, Denmark
Submit requests for reprints to: Research Professor Charlotte Leboeuf-Yde, DC, MPH, PhD, The Research Center, Backcenter Funen, Lindevej 5, Dk-5750 Ringe, Denmark.
Sources of support: funding was provided by the Research Council of Norway and the Swedish Chiropractic Association.
ABSTRACT