Abstract
Objectives
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.
Methods
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.
Results
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.
Conclusions
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.
Key Indexing Terms
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Article info
Publication history
Published online: August 02, 2012
Accepted:
April 23,
2012
Received in revised form:
April 13,
2012
Received:
January 7,
2012
Identification
Copyright
© 2012 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.
