Abstract
Background: Although chiropractors often use physical modalities with spinal manipulation, evidence
that modalities yield additional benefits over spinal manipulation alone is lacking.
Objective: The purpose of the study was to estimate the net effect of physical modalities on
low back pain (LBP) outcomes among chiropractic patients in a managed-care setting.
Methods: Fifty percent of the 681 patients participating in a clinical trial of LBP treatment
strategies were randomized to chiropractic care with physical modalities (n = 172)
or without physical modalities (n = 169). Subjects were followed for 6 months with
assessments at 2, 4, and 6 weeks and at 6 months. The primary outcome variables were
average and most severe LBP intensity in the past week, assessed with numerical rating
scales (0-10), and low back–related disability, assessed with the 24-item Roland-Morris
Disability Questionnaire. Results: Almost 60% of the subjects had baseline LBP episodes of more than 3 months’ duration.
The 6-month follow-up was 96%. The adjusted mean differences between groups in improvements
in average and most severe pain and disability were clinically insignificant at all
follow-up assessments. Clinically relevant improvements in average pain and disability
were more likely in the modalities group at 2 and 6 weeks, but this apparent advantage
disappeared at 6 months. Perceived treatment effectiveness was greater in the modalities
group. Conclusions: Physical modalities used by chiropractors in this managed-care organization did not
appear to be effective in the treatment of patients with LBP, although a small short-term
benefit for some patients cannot be ruled out.
Keywords
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Article info
Publication history
Received:
June 11,
2001
Footnotes
*This study was funded by grants from the Agency for Healthcare Research and Quality (AHRQ) and the Southern California University of Health Sciences. Dr Hurwitz was supported by a grant from the National Center for Complementary and Alternative Medicine (NCCAM).
**Submit reprint requests to: Eric L. Hurwitz, DC, PhD, UCLA School of Public Health, Department of Epidemiology, Box 951772, Los Angeles, CA 90095-1772, USA. E-mail: [email protected]
Identification
Copyright
© 2002 JMPT. Published by Elsevier Inc. All rights reserved.
