A randomized trial of chiropractic and medical care for patients with low back p

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Spine. 2006 Mar 15;31(6):611-21; discussion 622.

A randomized trial of chiropractic and medical care for patients with

low back pain: eighteen-month follow-up outcomes from the UCLA low

back pain study.

Hurwitz EL, Morgenstern H, Kominski GF, Yu F, Chiang LM.

Department of Epidemiology, UCLA School of Public Health, Los

Angeles, CA, USA.

STUDY DESIGN: Randomized clinical trial.

OBJECTIVES: To compare the long-term effectiveness of medical and

chiropractic care for low back pain in managed care and to assess the

effectiveness of physical therapy and modalities among patients

receiving medical or chiropractic care.

SUMMARY OF BACKGROUND DATA: Evidence comparing the long-term relative

effectiveness of common treatment strategies offered to low back pain

patients in managed care is lacking.

METHODS: A total of 681 low back pain patients presenting to a

managed-care facility were randomized to chiropractic with or without

physical modalities, or medical care with or without physical

therapy, and followed for 18 months. The primary outcome variables

are low back pain intensity, disability, and complete remission. The

secondary outcome is participants' perception of improvement in low

back symptoms.

RESULTS: Of the 681 patients, 610 (89.6%) were followed through 18

months. Among participants not assigned to receive physical therapy

or modalities, the estimated improvements in pain and disability and

18-month risk of complete remission were a little greater in the

chiropractic group than in the medical group (adjusted RR of

remission = 1.29; 95% CI = 0.80-2.07). Among participants assigned to

medical care, mean changes in pain and disability and risk of

remission were larger in patients assigned to receive physical

therapy (adjusted RR = 1.69; 95% CI = 1.08-2.66). Among those

assigned to chiropractic care, however, assignment to methods was not

associated with improvement or remission (adjusted RR = 0.98; 95% CI

= 0.62-1.55). Compared with medical care only patients, chiropractic

and physical therapy patients were much more likely to perceive

improvement in their low back symptoms. However, less than 20% of all

patients were pain-free at 18 months.

CONCLUSIONS: Differences in outcomes between medical and chiropractic

care without physical therapy or modalities are not clinically

meaningful, although chiropractic may result in a greater likelihood

of perceived improvement, perhaps reflecting satisfaction or lack of

blinding. Physical therapy may be more effective than medical care

alone for some patients, while physical modalities appear to have no

benefit in chiropractic care.