New Study Finds Chiropractic Care Superior to Family Physician-directed Usual Care

The Chiro.Org Blog


SOURCE:   Spine J. 2010 (Oct 2)   [Epub ahead of print]

Bishop PB, Quon JA, Fisher CG, Dvorak MF.

International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada. paul.bishop@vch.ca


This newly published (Oct 2) study in Spine Journal compared family physician-directed usual care with evidence-based clinical practice guidelines (CPGs) (which includes reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar chiropractic spinal manipulative care, and return to work within 8 weeks) on patients with acute low back pain. [1]

Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear. To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician-directed usual care (UC), a two-arm, parallel design, prospective, randomized controlled clinical trial using blinded outcome assessment was designed. Treatment was administered in a hospital-based spine program outpatient clinic. Patients were assessed by a spine physician, then randomized to SC (reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar CSMT, and return to work within 8 weeks), or family physician-directed UC, the components of which were recorded.

Primary outcomes involved improvement from baseline in Roland-Morris Disability Questionnaire (RDQ) scores at 16 weeks. Secondary outcomes involved improvements in RDQ scores at 8 and 24 weeks; and in Short Form-36 (SF-36) bodily pain (BP) and physical functioning (PF) scale scores at 8, 16, and 24 weeks.

RESULTS: Ninety-two patients were recruited, with 36 SC and 35 UC patients completing all follow-up visits. Baseline prognostic variables were evenly distributed between groups. The primary outcome, the unadjusted mean improvement in Roland-Morris Disability scores, was significantly greater in the chiropractic group than in the UC group (p=.003). Regarding unadjusted mean changes in secondary outcomes, improvements in Roland-Morris scores were also greater in the chiropractic group at other time points, particularly at 24 weeks (p=.004). Similarly, improvements in SF-36 PF scores favored the chiropractic group at all time points; however, these differences were not statistically significant.

CONCLUSIONS: This is the first reported randomized controlled trial comparing full CPG-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed UC in the treatment of patients with AM-LBP. Compared to family physician-directed UC, full CPG-based treatment including spinal manipulative care (CSMT) is associated with significantly greater improvement in condition-specific functioning.


This re-confirms the findings of the UK BEAM Trial, published in the British Medical Journal in 2004. [2] Most patients with acute back pain improve over time, but adding spinal manipulation followed by exercise to standard care moderately improves results. The UK BEAM trial team (page 1377) randomised 1334 patients with low back pain to additional exercise classes, spinal manipulation, or manipulation followed by exercise or to “best care” in general practice. Manipulation, with or without exercise, improved symptoms more than best care (medical care) alone after three and 12 months. However, analysis of the cost utility of different strategies shows that manipulation alone probably gives better value for money than manipulation followed by exercise (page 1381).

The Low Back Pain and Chiropractic Page contains numerous other studies, dating back to the early 1990s, that demonstrate the vast superiority (and safety) of chiropractic management for low back pain.

You may also want to review the editorial titled:
End Medical Mis-Management of Low Back Pain
as it encapsulates many of those same findings.


REFERENCES:

1. Findings from the: “United Kingdom Back Pain Exercise and Manipulation (UK BEAM) Randomised Trial”
British Medical Journal 2004 (Dec 11); 329 (7479): 1381 ~ FULL TEXT

2. The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain
Spine J. 2010 Oct 2. [Epub ahead of print]