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The Chiropractic Hospital-Based Interventions Research Outcomes Study

The Chiropractic Hospital-Based Interventions Research Outcomes Study: Consistency of Outcomes Between Doctors of Chiropractic Treating Patients With Acute Lower Back Pain

The Chiro.Org Blog


SOURCE:   J Manipulative Physiol Ther. 2015 (Jun 24) ~ FULL TEXT

Jeffrey A. Quon, DC, MHSc, PhD, FCCS(C), Paul B. Bishop, DC, MD, PhD,
Brian Arthur, DC, MSc

Clinical Associate Professor,
Faculty of Medicine,
School of Population and Public Health,
University of British Columbia


Introduction

Within mainstream health care, the customary management of low back pain (LBP) by primary care medical physicians is often not evidence based. Interestingly, clinical practice guidelines (CPG) for the treatment of acute mechanical LBP, for example, have been developed independently by multidisciplinary expert panels in 12 countries. [1-12]

The recommendations from those guidelines have been further accompanied by rigorous systematic reviews of the evidence [13-15] rather than expert consensus alone, [1] and, to date, they have generally endorsed the use of the following conservative modalities:

(1) reassurance about the favorable natural history of acute LBP,

(2) early activation,

(3) time-limited nonsteroidal anti-inflammatory medication
(barring contraindications), and

(4) spinal manipulative therapy (SMT).

Despite widespread dissemination of CPG for LBP, compliance with this knowledge in general and with the SMT component in particular has been limited among mainstream health care providers. This is particularly true among family medical physicians, [16-18] whose personal beliefs about effective LBP care are often discordant with what is known from external research evidence. [19, 20] Yet, ironically, family medical physicians account for most office visits for LBP in many North American jurisdictions. [21]

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In the province of British Columbia, Canada, family medical physicians represent the most common portal of entry into the health care system for patients with LBP. In an earlier observational study of injured workers, only 6% of attending family physicians recommended guideline-concordant spinal manipulation for acute LBP, whereas 54% recommended guideline discordant passive physiotherapy even after 4 weeks postinjury. [16] In a subsequent randomized controlled trial (RCT), only 17% of family physicians ended up recommending guideline concordant spinal manipulation, even after receiving a copy of CPG for the management of acute LBP as well as letters at 3 stages of the patient’s clinical course, specifically urging compliance with the distributed information. [17]


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