Prize-winning papers from the World Federation of Chiropractic 6th Biennial Congress| Volume 25, ISSUE 1, P10-20, January 2002

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Second prize The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: Findings from the UCLA Low Back Pain Study


      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.


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        • Hurwitz EL
        • Coulter ID
        • Adams AH
        • Genovese BJ
        • Shekelle PG
        Use of chiropractic services from 1985 through 1991 in the United States and Canada.
        Am J Public Health. 1998; 88: 771-776
        • Druss BG
        • Rosenheck RA
        Association between use of unconventional therapies and conventional medical services.
        JAMA. 1999; 282: 651-656
        • Eisenberg DM
        • Davis RB
        • Ettner SL
        • Appel S
        • Wilkey S
        • Van Rompay M
        • et al.
        Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey.
        JAMA. 1998; 280: 1569-1575
        • Shekelle PG
        • Brook RH
        A community-based study of the use of chiropractic services.
        Am J Public Health. 1991; 81: 439-442
        • Woodwell DA
        National ambulatory medical care survey: 1997 summary. Advance data from vital and health statistics, No. 305.
        National Center for Health Statistics, Hyattsville (MD)1999
        • Waddell G
        Low back pain: a twentieth century health care enigma.
        Spine. 1996; 21: 2820-2825
        • Guo H-R
        • Tanaka S
        • Halperin WE
        • Cameron LL
        Back pain prevalence in US industry and estimates of lost workdays.
        Am J Public Health. 1999; 89: 1029-1035
        • Murphy PL
        • Volinn E
        Is occupational low back pain on the rise?.
        Spine. 1999; 247: 691-697
        • Bigos S
        • Bowyer O
        • Braen G
        • Brown K
        • Deyo R
        • Haldeman S
        • et al.
        Acute low back problems in adults.
        (Clinical practice guideline No. 14. AHCPR Publication No. 95-0642) Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, Rockville (MD)1994
        • van Tulder MW
        • Koes BW
        • Bouter LM
        Conservative treatment of acute and chronic nonspecific low back pain: a systematic review of randomized controlled trials of the most common interventions.
        Spine. 1997; 22: 2128-2156
        • Cherkin DC
        • Mootz RD
        Chiropractic in the United States: training, practice, and research.
        (AHCPR Publication No. 98-N002 74-6) Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, Rockville (MD)1997
        • Christensen MG
        • Kerkoff D
        • Kollasch MW
        Job analysis of chiropractic 2000.
        in: National Board of Chiropractic Examiners, Greeley (CO)2000: 129
        • Feine JS
        • Lund JP
        An assessment of the efficacy of physical therapy and physical modalities for the control of chronic musculoskeletal pain.
        Pain. 1997; 71: 5-23
        • Nordin M
        • Campello M
        Physical therapy. Exercises and the modalities: when, what and why?.
        Neurol Clin North Am. 1999; 17: 75-89
        • Roland M
        • Morris R
        A study of the natural history of back pain—part I: development of a reliable and sensitive measure of disability in low-back pain.
        Spine. 1983; 8: 141-150
        • Deyo RA
        Comparative validity of sickness impact profile and shorter scales for functional assessment in low-back pain.
        Spine. 1986; 11: 951-954
        • Jensen MP
        • Strom SE
        • Turner JA
        • Romano JM
        Validity of the sickness impact profile Roland scale as a measure of dysfunction in chronic pain patients.
        Pain. 1992; 50: 157-162
        • Deyo RA
        • Centor RM
        Assessing responsiveness of functional scales to clinical change: analogy to diagnostic test performance.
        J Chronic Dis. 1986; 39: 897-906
        • Hsieh CJ
        • Phillips RB
        • Adams AH
        • Pope MH
        Functional outcomes of low back pain: comparison of four treatment groups in a randomized controlled trial.
        J Manipulative Physiol Ther. 1992; 15: 4-9
        • Stratford PW
        • Binkley J
        • Solomon P
        • Gill C
        • Finch E
        Assessing change over time in patients with low back pain.
        Phys Ther. 1994; 74: 528-533
        • Bouter LM
        • van Tulder MW
        • Koes BW
        Methodologic issues in low back pain research in primary care.
        Spine. 1998; 23: 2014-2020
        • Roland M
        • Fairbank J
        The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire.
        Spine. 2000; 25: 3115-3124
        • Strong J
        • Ashton R
        • Chant D
        Pain intensity measurement in chronic low back pain.
        Clin J Pain. 1991; 7: 209-218
        • Von Korff M
        • Jensen MP
        • Karoly P
        Assessing global pain severity by self-report in clinical and health services research.
        Spine. 2000; 25: 3140-3151
        • Ware JE
        • Sherbourne CD
        The MOS 36-Item Short-Form Health Survey (SF-36): I. Conceptual framework and item selection.
        Med Care. 1992; 30: 473-483
        • McHorney CA
        • Ware JE
        Construction and validation of an alternate form general mental health scale for the Medical Outcomes Study Short-Form Health Survey.
        Med Care. 1995; 33: 15-28
        • Ware JE
        SF-36 Health survey update.
        Spine. 2000; 25: 3130-3139
        • Patrick DL
        • Deyo RA
        • Atlas SJ
        • Singer DE
        • Chapin A
        • Keller RB
        Assessing health-related quality of life in patients with sciatica.
        Spine. 1995; 20: 1899-1909
        • Deyo RA
        • Battie M
        • Beurskens AJHM
        • Bombardier C
        • Croft P
        • Koes B
        • et al.
        Outcome measures for low back pain research: a proposal for standardized use.
        Spine. 1998; 23: 2003-2013
        • SAS Institute Inc
        The SAS System for Windows 8.1.
        SAS Institute Inc, Cary, North Carolina2000
        • Shekelle PG
        • Adams AH
        • Chassin MR
        • Hurwitz EL
        • Brook RH
        Spinal manipulation for low-back pain.
        Ann Intern Med. 1992; 117: 590-598
        • Assendelft WJJ
        • Bouter LM
        • Knipschild PG
        Complications of spinal manipulation: a comprehensive review of the literature.
        J Fam Pract. 1996; 42: 475-480
        • Meade TW
        • Dyer S
        • Browne W
        • Townsend J
        • Frank AO
        Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment.
        BMJ. 1990; 300: 1431-1437
        • Meade TW
        • Dyer S
        • Browne W
        • Frank AO
        Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow-up.
        BMJ. 1995; 311: 349-351
        • Postacchini F
        • Facchini M
        • Palieri P
        Efficacy of various forms of conservative treatment in low back pain: a comparative study.
        Neuroorthop. 1988; 6: 28-35
        • Skargren EI
        • Oberg BE
        • Carlsson PG
        • Gade M
        Cost and effectiveness analysis of chiropractic and physiotherapy treatment for low back and neck pain: six-month follow-up.
        Spine. 1997; 22: 2167-2177
        • Skargren EI
        • Carlsson PG
        • Oberg BE
        One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain: subgroup analysis, recurrence, and additional health care utilization.
        Spine. 1998; 23: 1875-1884
        • Cherkin DC
        • Deyo RA
        • Battie M
        • Street J
        • Barlow W
        A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain.
        N Engl J Med. 1998; 339: 1021-1029
        • Moffett JK
        • Torgerson D
        • Bell-Syer S
        • Jackson D
        • Llewlyn-Phillips H
        • Farrin A
        • et al.
        Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences.
        BMJ. 1999; 319: 279-283
        • Torstensen TA
        • Ljunggren AE
        • Meen HD
        • Odland E
        • Mowinckel P
        • Geijerstam S
        Efficiency and costs of medical exercise therapy, conventional physiotherapy, and self-exercise in patients with chronic low back pain. A pragmatic, randomized, single-blinded, controlled trial with 1-year follow-up.
        Spine. 1998; 23: 2616-2624
        • Frost H
        • Lamb SE
        • Klaber Moffett JA
        • Fairbank JCT
        • Moser JS
        A fitness programme for patients with chronic low back pain: 2-year follow-up of a randomised controlled trial.
        Pain. 1998; 75: 273-279
        • Mannion AF
        • Muntener M
        • Taimela S
        • Dvorak J
        A randomized clinical trial of three active therapies for chronic low back pain.
        Spine. 1999; 24: 2435-2448
        • Leclaire R
        • Esdaile JM
        • Suissa S
        • Rossignol M
        • Prouix R
        • Dupuis M
        Back school in a first episode of compensated acute low back pain: a clinical trial to assess efficacy and prevent relapse.
        Arch Phys Med Rehabil. 1996; 77: 673-679
        • Malmivaara A
        • Hakkinen U
        • Aro T
        • Heinrichs CL
        • Koskenniemi L
        • Kuosma E
        The treatment of acute low back pain—bed rest, exercises, or ordinary activity?.
        N Engl J Med. 1995; 332: 351-355
        • Stucki G
        • Liang MH
        • Fossel AH
        • Katz JN
        Relative responsiveness of condition-specific and general health status measures in degenerative lumbar spinal stenosis.
        J Clin Epidemiol. 1995; 48: 1369-1378
        • Stratford PW
        • Binkley J
        • Solomon P
        • Finch E
        • Gill C
        • Moreland J
        Defining the minimum level of detectable change for the Roland-Morris questionnaire.
        Phys Ther. 1996; 76: 359-365
        • Burton AK
        • Tillotson KM
        • Main CJ
        • Hollis S
        Psychosocial predictors of outcome in acute and subchronic low back trouble.
        Spine. 1995; 20: 722-728