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Abstract
Background: Few studies exist on the prognostic value of demographic, clinical, or psychosocial
factors on long-term outcomes for patients with chronic low back pain.
Objective: This study reports on long-term pain and disability outcomes for patients with chronic
low back pain, evaluates predictors of long-term outcomes, and assesses the influence
of doctor type on clinical outcome.
Methods: Sixty chiropractic (DC) and 111 general practice (MD) physicians participated in
data collection for a prospective, longitudinal, practice-based, observational study
of ambulatory low back pain of mechanical origin. The primary outcomes, measured at
6 months and 12 months, were pain (by using the Visual Analog Scale), and functional
disability (by using the Revised Oswestry Disability Questionnaire). Satisfaction
was a secondary outcome.
Results: Overall, long-term pain and disability outcomes were generally equivalent for patients
seeking care from medical or chiropractic physicians. Medical and chiropractic care
were comparable for patients without leg pain and for patients with leg pain above
the knee. However, an advantage was noted for chronic chiropractic patients with radiating
pain below the knee after adjusting for baseline differences in patient and complaint
characteristics between MD and DC cohorts (adjusted differences = 8.0 to 15.2; P < .002). A greater proportion of chiropractic patients were satisfied with all aspects
of their care (P = .0000). The strongest predictors of primary outcomes included an interaction of
radiating pain below the knee with provider type and baseline values of the outcomes.
Income, smoking, comorbidity, and chronic depression were also identified as predictors
of outcomes in this study.
Conclusion: Chiropractic care compared favorably to medical care with respect to long-term pain
and disability outcomes. Further study is required to explore the advantage seen for
chiropractic care in patients with leg pain below the knee and in the area of patient
satisfaction. Identification of patient and treatment characteristics associated with
better or worse outcomes may foster changes in physicians' practice activities that
better serve these patients' needs.
Key Indexing Terms
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Article info
Publication history
Received:
June 15,
2000
Footnotes
Funded by a grant from the Bureau of Health Professions of the Department of Health and Human Services. Support for the Center for Outcome Studies' infrastructure was provided by a grant from the Foundation for Chiropractic Education and Research.
Identification
Copyright
© 2001 Journal of Manipulative and Physiological Therapeutics. Published by Elsevier Inc.
