Original Article| Volume 35, ISSUE 7, P525-533, September 2012

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Predictors of Improvement in Patients With Acute and Chronic Low Back Pain Undergoing Chiropractic Treatment

Published:August 02, 2012DOI:



      The purpose of this study was to investigate outcomes and prognostic factors in patients with acute or chronic low back pain (LBP) undergoing chiropractic treatment.


      This was a prognostic cohort study with medium-term outcomes. Adult patients with LBP of any duration who had not received chiropractic or manual therapy in the prior 3 months were recruited from multiple chiropractic practices in Switzerland. Participating doctors of chiropractic were allowed to use their typical treatment methods (such as chiropractic manipulation, soft tissue mobilization, or other methods) because the purpose of the study was to evaluate outcomes from routine chiropractic practice. Patients completed a numerical pain rating scale and Oswestry disability questionnaire immediately before treatment and at 1 week, 1 month, and 3 months after the start of treatment, together with self-reported improvement using the Patient Global Impression of Change.


      Patients with acute (<4 weeks; n = 523) and chronic (>3 months; n = 293) LBP were included. Baseline mean pain and disability scores were significantly (P < .001) higher in patients with acute LBP. In both groups of patients, there were significant (P < .0001) improvements in mean scores of pain and disability at 1 week, 1 month, and 3 months, although these change scores were significantly greater in the acute group. Similarly, a greater proportion of patients in the acute group reported improvement at each follow-up. The most consistent predictor was self-reported improvement at 1 week, which was independently associated with improvement at 1 month (adjusted odds ratio [OR], 2.4 [95% confidence interval, 1.3-4.5] and 5.0 [2.4-10.6]) and at 3 months (2.9 [1.3-6.6] and 3.3 [1.3-8.7]) in patients with acute and chronic pain, respectively. The presence of radiculopathy at baseline was not a predictor of outcome.


      Patients with chronic and acute pain reporting that they were “much better” or “better” on the Patient Global Impression of Change scale at 1 week after the first chiropractic visit were 4 to 5 times more likely to be improved at both 1 and 3 months compared with patients who were not improved at 1 week. Patients with acute pain reported more severe pain and disability initially but recovered faster. Patients with chronic and acute back pain both reported good outcomes, and most patients with radiculopathy also improved.

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        • Globe GA
        • Morris CE
        • Whalen WM
        • Farabaugh RJ
        • Hawk C
        Chiropractic management of low back disorders: report from a consensus process.
        J Manipulative Physiol Ther. 2008; 31: 651-658
        • Flynn T
        • Fritz J
        • Whitman J
        • Wainner R
        • Magel J
        • Rendeiro D
        • et al.
        A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation.
        Spine. 2002; 27: 2835-2843
        • Khorsan R
        • Coulter ID
        • Hawk C
        • Choate CG
        Measures in chiropractic research: choosing patient-based outcome assessments.
        J Manipulative Physiol Ther. 2008; 31: 355-375
        • Brontfort G
        • Haas M
        • Evans RL
        • Bouter LM
        Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis.
        Spine J. 2004; 4: 335-356
        • Assendelft WJJ
        • Morton SC
        • Yu EI
        • Suttorp MJ
        • Shekelle PG
        Spinal manipulative therapy for low-back pain.
        Cochrane Database Syst Rev. 2004; : CD000447
        • Ferreira ML
        • Ferreira PH
        • Latimer J
        • Herbert R
        • Maher CG
        Efficacy of spinal manipulative therapy for low back pain of less than three months' duration. Review of the literature.
        J Manipulative Physiol Ther. 2003; 26: 593-601
        • Haas M
        • Groupp E
        • Kraemer DF
        Dose-response for chiropractic care of chronic low back pain.
        Spine J. 2004; 4: 574-583
        • LeBoeuf-Yde C
        • Grønstvedt A
        • Borge JA
        • Lothe J
        • Magnesen E
        • Nilsson Ø
        • et al.
        The Nordic back pain subpopulation program: a 1-year prospective multicenter study of outcomes of persistent low-back pain in chiropractic patients.
        J Manipulative Physiol Ther. 2005; 28: 90-96
        • LeBoeuf-Yde C
        • Grønstvedt A
        • Borge JA
        • Lothe J
        • Magnesen E
        • Nilsson Ø
        • et al.
        The Nordic back pain subpopulation program: demographic and clinical predictors for outcome in patients receiving chiropractic treatment for persistent low-back pain.
        J Manipulative Physiol Ther. 2004; 27: 493-502
        • Lawrence DJ
        • Meeker W
        • Branson R
        • Bronfort G
        • Cates JR
        • Haas M
        • et al.
        Chiropractic management of low back pain and low back–related leg complaints: a literature synthesis.
        J Manipulative Physiol Ther. 2008; 31: 659-674
        • Fritz JM
        • Whitman JM
        • Flynn TW
        • Wainner RS
        • Childs JD
        Factors related to the inability of individuals with low back pain to improve with a spinal manipulation.
        Phys Ther. 2004; 84: 173-190
        • Childs JD
        • Fritz JM
        • Flynn TW
        • Irrgang JJ
        • Johnson KK
        • Majkowske M
        • et al.
        A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study.
        Ann Intern Med. 2004; 141: 920-928
        • Kongsted A
        • Leboeuf-Yde C
        The Nordic back pain subpopulation program—individual patterns of low back pain established by means of text messaging: a longitudinal pilot study.
        Chiropr Osteopat. 2009; 17: 11
        • Kongsted A
        • Leboeuf-Yde C
        The Nordic back pain subpopulation program: course patterns established through weekly follow-ups in patients treated for low back pain.
        Chiropr Osteopat. 2010; 18: 2
        • Axén I
        • Rosenbaum A
        • Röbech R
        • Wren T
        • Leboeuf-Yde C
        Can patient reactions to the first chiropractic treatment predict early favorable treatment outcome in persistent low back pain?.
        J Manipulative Physiol Ther. 2002; 25: 450-454
        • Pengel LHM
        • Hervert RD
        • Maher CG
        • Refshauge KM
        Acute low back pain: systematic review of its prognosis.
        BMJ. 2003; 327: 323-325
        • Kent PM
        • Keating JL
        The epidemiology of low back pain in primary care.
        Chiropr Osteopat. 2005; 13: 13
        • Martin BI
        • Deyo RA
        • Mirza SK
        • Turner JA
        • Comstock BA
        • Hollinworth W
        • et al.
        Expenditures and health status among adults with back and neck problems.
        JAMA. 2008; 299: 656-664
        • Becker A
        • Held H
        • Redaelli M
        • Strauch K
        • Chenot JF
        • Leonhardt C
        • et al.
        Low back pain in primary care: costs of care and prediction of future health care utilization.
        Spine. 2010; 35: 1714-1720
        • Humphreys BK
        • Peterson CK
        • Muehlemann D
        • Haueter P
        Are Swiss chiropractors so different? Results from the Swiss Job Analysis Survey 2009.
        J Manipulative Physiol Ther. 2010; 33: 519-535
        • Mannion AF
        • Junge A
        • Fairbank JCT
        • Dvorak J
        • Grob D
        Development of a German version of the Oswestry disability index. Part 1: cross-cultural adaptation, reliability, and validity.
        Eur Spine J. 2006; 15: 55-65
        • Vogler D
        • Paillex R
        • Norberg N
        • de Goumoëns P
        • Cabri J
        Cross-cultural validation of the Oswestry disability index in French.
        Ann Réadapt Méd Phys. 2008; 51: 379-385
        • Fischer D
        • Stewart AL
        • Bloch DA
        • Lorig K
        • Laurent D
        • Holman H
        Capturing the patient's view of change as a clinical outcome measure.
        JAMA. 1999; 282: 1157-1162
        • Malmqvist S
        • LeBoeuf-Yde C
        • Ahola T
        • Andersson O
        • Ekström K
        • Pekkarinen H
        • et al.
        The Nordic back pain subpopulation program: predicting outcome among chiropractic patients in Finland.
        Chiropr Osteopat. 2008; 16: 13
        • Ostelo RW
        • Deyo RA
        • Stratford P
        • Waddell G
        • Croft P
        • Von Korff M
        • et al.
        Interpreting change scores for pain and functional status in low back pain.
        Spine. 2008; 33: 90-94
        • Kongsted A
        • Leboeuf-Yde C
        The Nordic back pain subpopulation program: can low back pain patterns be predicted from the first consultation with a chiropractor? A longitudinal pilot study.
        Chiropr Osteopat. 2010; 18: 8
        • Spratt KF
        • Weinstein JN
        • Lehmann TR
        • Woody J
        • Sayre H
        Efficacy of flexion and extension treatments incorporating braces for low back patients with retrodisplacement, spondylolisthesis, or normal sagittal translation.
        Spine. 1993; 18: 1839-1849
        • Nakipoglu GF
        • Karagöz A
        • Özgirgin N
        The Biomechanics of the lumbosacral region in acute and chronic low back pain patients.
        Pain Physician. 2008; 11: 505-511
        • Brennan GP
        • Fritz JM
        • Hunter SJ
        • Thackeray A
        • Delitto A
        • Erhard RE
        Identifying subgroups of patients with acute/subacute “nonspecific” low back pain. Results of a randomized clinical trial.
        Spine. 2006; 31: 623-631
        • Axén I
        • Jones JJ
        • Rosenbaum A
        • Lövgren PW
        • Halasz L
        • Larsen K
        • et al.
        The Nordic back pain subpopulation program: validation and improvement of a predictive model for treatment outcome in patients with low back pain receiving chiropractic treatment.
        J Manipulative Physiol Ther. 2005; 28: 381-385
        • Hays RD
        • Kim S
        • Spritzer KL
        • Kaplan RM
        • Tally S
        • Feeny D
        • et al.
        Effects of mode and order of administration on generic health-related quality of life scores.
        Value Health. 2009; 12: 1035-1039
        • Hanmer J
        • Hays RD
        • Fryback DG
        Mode of administration is important in US national estimates of health-related quality of life.
        Med Care. 2007; 45: 1171-1179
        • Power JR
        • Mishra G
        • Young AF
        Differences in mail and telephone responses to self-rated health: use of multiple imputation in correcting for response bias.
        Aust N Z J Public Health. 2005; 29: 149-154