Abstract
Objective
To identify demographic and clinic-related predictors for successful outcome in patients
with persistent low-back pain who received chiropractic treatment.
Design
Prospective uncontrolled multicenter study with internal control groups.
Subjects
Each of 115 Norwegian chiropractors, out of 205 invited, were asked to recruit 10
consecutive patients who had low-back pain for at least 2 weeks at the time of consultation
and a minimum of 30 days altogether within the preceding year. In all, 875 patients
were included at baseline. The response rates at the fourth visit and at 3 and 12
months were 799, 598, and 512, respectively.
Methods
Baseline data were obtained through questionnaires administered to chiropractic patients
and to their treating chiropractors; clinical information was obtained through questionnaires
at the fourth visit from patients and chiropractors. Outcome was obtained from patients
at the fourth visit. Mail surveys of patients were conducted after 3 and 12 months,
and additional information was obtained from chiropractors at 12 months in relation
to treatment history.
Potential Predictors
Demography and information on past and present history, clinical findings, and prognosis.
Outcome Variable
Number of low-back pain–free patients (defined as those with a maximum pain score
of 1/10 and a maximum Oswestry score of 15/100).
Data Analysis
Positive predictive values and relative risks were calculated for each categorized
predictor variable singly and in combination in relation to being low-back pain free
at the 3 follow-up surveys.
Results
Treatment outcome at the fourth visit was best predicted by a model containing the
following 5 variables: sex, social benefit, severity of pain, duration of continuous
pain at first consultation, and additional neck pain (odds ratios between 2.2 and
4.3). A similar profile was found at 3 months, but 2 different variables (relating
to disability) were the final variables in relation to the 12-month status. These
final models were best at predicting absence of treatment success. Being low-back
pain free at the fourth visit was a strong predictor for being low-back pain free
both at 3 months and 12 months, with relative risks of 3.0 (2.2-4.8) and 3.1 (1.5-6.5),
respectively.
Conclusion
In patients with persistent low-back pain, it is possible to exclude from treatment
those who are unlikely to become low-back pain free after chiropractic care and to
do this before they have been examined clinically. Early recovery is a strong predictor
for outcome up to 1 year later.
Key Indexing Terms
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Article info
Publication history
Received in revised form:
August 14,
2003
Received:
July 17,
2003
Footnotes
Supported by the Research Council of Norway and the Swedish Chiropractic Association.
Identification
Copyright
© 2004 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
