Journal of Manipulative and Physiological Therapeutics
Volume 32, Issue 9 , Pages 723-733, November 2009

A Nonsurgical Approach to the Management of Patients With Lumbar Radiculopathy Secondary to Herniated Disk: A Prospective Observational Cohort Study With Follow-Up

  • Donald R. Murphy, DC

      Affiliations

    • Clinical Director, Rhode Island Spine Center, Pawtucket, RI
    • Clinical Assistant Professor, Department of Community Health, Warren Alpert Medical School of Brown University, Providence, RI
    • Adjunct Associate Professor, Department of Research, New York Chiropractic College, Seneca Falls, NY
    • Corresponding Author InformationSubmit requests for reprints to: Donald R. Murphy, DC, Rhode Island Spine Center, 600 Pawtucket Avenue, Pawtucket, RI 02860
    • ,
  • Eric L. Hurwitz, DC, PhD

      Affiliations

    • Associate Professor of Epidemiology, Department of Public Health Sciences and Epidemiology, John A. Burns School of Medicine, University of Hawaii, Mānoa, Hawaii
    • ,
  • Ericka E. McGovern, DC

      Affiliations

    • Staff Chiropractic Physician, Rhode Island Spine Center, Pawtucket, RI

Received 18 April 2009; received in revised form 15 July 2009; accepted 27 July 2009.

Abstract 

Objective

This study presents the outcomes of patients with lumbar radiculopathy secondary to disk herniation treated after a diagnosis-based clinical decision rule.

Methods

A prospective observational cohort study was conducted at a multidisciplinary, integrated clinic that includes chiropractic and physical therapy health care services. Data on 49 consecutive patients were collected at baseline, at the end of conservative, nonsurgical treatment and a mean of 14.5 months after cessation of treatment. Disability was measured using the Bournemouth Disability Questionnaire (BDQ) and pain using the Numerical Rating Scale for pain. Fear beliefs were measured with the Fear-Avoidance Beliefs Questionnaire (FABQ). Patients also self-rated improvement.

Results

Mean duration of complaint was 60.5 weeks. Mean self-rated improvement at the end of treatment was 77.5%. Improvement was described as “good” or “excellent” in nearly 90% of patients. Mean percentage improvement on the BDQ was 60.4%. Numerical Rating Scale improved 4.1 points and FABQ improved 4.8 points. Clinically meaningful improvements in pain and disability were seen in 79% and 70% of patients, respectively. Mean number of visits was 13.2. After an average long-term follow-up of 14.5 months, mean self-rated improvement was 81.1%. “Good” or “excellent” improvement was reported by 80% of patients. Mean percentage improvement in BDQ was 67.4%. Numerical Rating Scale improved 4.2 points and FABQ 4.5 points. Clinically meaningful improvements in pain and disability were seen in 79% and 73% of patients, respectively.

Conclusions

Management based on the decision rule yielded favorable outcomes in this cohort study. Improvement appeared to be maintained over the long term.

Key Indexing Terms: Lumbar Region, Radiculopathy, Disk, Herniated, Lumbar Manipulation, Sciatica, Chiropractic, Delivery of Health Care, Integrated

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 15.00 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

PII: S0161-4754(09)00271-1

doi:10.1016/j.jmpt.2009.10.007

Journal of Manipulative and Physiological Therapeutics
Volume 32, Issue 9 , Pages 723-733, November 2009

Article Tools

* Image Usage & Resolution