Abstract
Background: Chronic low-back pain is a significant public health problem for which few therapies
are supported by predictable outcomes. In this report, practice activities and 1-month
outcomes data are presented for 93 chiropractic patients and 45 medical patients with
chronic, recurrent low-back pain. Design: A prospective, observational, community-based feasibility study involving chiropractors
and family medicine physicians. Setting: Forty private chiropractic clinics, the outpatient clinic of the Department of Family
Medicine at Oregon Health Sciences University, and 5 other Portland area family medicine
clinics. Outcomes Measures: The main outcome measures were pain severity, functional disability, sensory and
affective pain quality at 1 month, and patient satisfaction assessed at 7 to 10 days
and at 1 month. Results: Although differences were noted in age, sex, education, and employment, the patients
were closely matched at baseline with respect to frequency, severity, and type of
low-back pain and the psychosocial dimensions of general health. The treatment of
choice for chiropractors was spinal manipulation and physical therapy modalities;
for medical physicians antiinflammatory agents were most frequently used. Chiropractic
patients averaged 4 visits, and medical patients averaged 1 visit. On average, chiropractic
patients showed improvement across all outcomes: 31% change in pain severity, 29%
in functional disability, 36% in sensory pain quality, and 57% in affective pain quality.
Medical patients showed minimal improvement in pain severity (6%) and functional disability
(1%) and showed deterioration in the sensory (29%) and affective (26%) dimensions
of pain quality. Satisfaction scores were higher for chiropractic patients. Outcomes
for medical patients were heavily dependent on psychosocial status at baseline. Conclusion: Patients with chronic low-back pain treated by chiropractors show greater improvement
and satisfaction at 1 month than patients treated by family physicians. Nonclinical
factors may play an important role in patient progress. Findings from the Health Resources
and Services Administration-funded project will include a report on the influence
of practice activities, including more frequent visits by chiropractic patients, on
the clinical course of low-back pain and patient outcomes. (J Manipulative Physiol
Ther 2000;23:239–45).
Keywords
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Article info
Publication history
Received:
June 4,
1999
Footnotes
*bInterim Director of Research, Western States Chiropractic College, Portland, Ore.
**cProfessor Emeritus, Department of Family Medicine, Oregon Health Sciences University, Portland, Ore.
*Funded by the Foundation for Chiropractic Education and Research, National Institute for Chiropractic Research, and Western States Chiropractic College. Portions of this article were presented at the 121st Annual Meeting of the American Public Health Association, San Francisco, California, October 24–28, 1993, and the International Forum for Primary Care Research on Low-Back Pain, Seattle, Washington, October 13–14, 1995.
**Submit reprint requests to: Joanne Nyiendo, PhD, Research Division, Western States Chiropractic College, 2900 NE 132nd Ave, Portland, OR 97230; [email protected]
*J Manipulative Physiol Ther 2000;23:239–45
Identification
Copyright
© 2000 JMPT. Published by Elsevier Inc. All rights reserved.
