A Randomized Controlled Trial Comparing 2 Types of Spinal Manipulation and Minimal Conservative Medical Care for Adults 55 Years and Older With Subacute or Chronic Low Back Pain
Received 4 February 2009; received in revised form 25 March 2009; accepted 25 March 2009.
Abstract
Objective
Chiropractic care is used by many older patients for low back pain (LBP), but there are no published results of randomized trials examining spinal manipulation (SM) for older adults. The purpose of this study was to compare the effects of 2 biomechanically distinct forms of SM and minimal conservative medical care (MCMC) for participants at least 55 years old with subacute or chronic nonradicular LBP.
Methods
Randomized controlled trial. The primary outcome variable was low back-related disability assessed with the 24-item Roland Morris Disability questionnaire at 3, 6, 12, and 24 weeks. Participants were randomly allocated to 6 weeks of care including 12 visits of either high-velocity, low-amplitude (HVLA)-SM, low-velocity, variable-amplitude (LVVA)-SM, or 3 visits of MCMC.
Results
Two hundred forty participants (105 women and 135 men) ages 63.1 ± 6.7 years without significant comorbidities. Adjusted mean Roland Morris Disability change scores (95% confidence intervals) from baseline to the end of active care were 2.9 (2.2, 3.6) and 2.7 (2.0, 3.3) in the LVVA-SM and HVLA-SM groups, respectively, and 1.6 (0.5, 2.8) in the MCMC group. There were no significant differences between LVVA-SM and HVLA-SM at any of the end points. The LVVA-SM group had significant improvements in mean functional status ranging from 1.3 to 2.2 points over the MCMC group. There were no serious adverse events associated with any of the interventions.
Conclusions
Biomechanically distinct forms of SM did not lead to different outcomes in older LBP patients and both SM procedures were associated with small yet clinically important changes in functional status by the end of treatment for this relatively healthy older population. Participants who received either form of SM had improvements on average in functional status ranging from 1 to 2.2 over those who received MCMC. From an evidence-based care perspective, patient preference and clinical experience should drive how clinicians and patients make the SM procedure decision for this patient population.
aAssociate Professor, Palmer Center for Chiropractic Research, Davenport, Iowa 52803
bProfessor, Palmer Center for Chiropractic Research, Davenport, Iowa 52803
cBiostatistician, Palmer Center for Chiropractic Research, Davenport, Iowa 52803
dAssistant Professor, Palmer College of Chiropractic, Davenport, Iowa 52803
ePresident, Palmer College of Chiropractic West, San Jose, Calif 95134
Submit requests for reprints to: Maria A. Hondras, DC, MPH, Associate Professor, Palmer Center for Chiropractic Research, 741 Brady Street, Davenport, IA 52803.
This work was supported in part by grants from the Bureau of Health Professions Health Resources and Services Administration, Rockville, MD (Grant No. 6 R18 HP01423-01), and the work was conducted in a facility constructed with support from Research Facilities Improvement Program Grant Number C06 RR15433-01 from the National Center for Research Resources, National Institutes of Health, Bethesda, Maryland. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the funding agencies. None of the authors have declared any personal, professional, financial, or any other conflict of interest.
ABSTRACT