Primary Topic: Manual medicine/body work (including chiropractic and massage)
Controlled trial evaluating the addition of chiropractic care to medical care for patients with low back pain
Christine M Goertz, DC, PhD; Cynthia R Long, Ph.D.; Robert D Vining, DC, Palmer College of Chiropractic, Davenport, IA, United States; Katherine A Pohlman, DC, MS, Parker University, Dallas, TX, United States; Joan Walter, JD, PA, Samueli Institute for Information Biology, Silver Spring, MD, United States; Ian D Coulter, PhD, RAND Corporation, Santa Monica, CA, United States
Late Breaker: No
There is a critical need to evaluate the impact of non-pharmacological treatments for low back pain (LBP) and associated disability. This trial determined whether the addition of chiropractic care to usual medical care (UMC) in patients with LBP resulted in better pain relief, pain-related function, patient satisfaction and perceived benefit after 6 weeks when compared to UMC alone.
This 3 site pragmatic comparative effectiveness trial adaptively allocated 750 active duty U.S. service members with LBP to 6 weeks of UMC plus chiropractic care or UMC alone. Co-primary outcomes, collected at baseline, 2, 4, 6 and 12 weeks, were LBP intensity (scale 0-10) and disability (Roland Morris Disability Questionnaire; 0-24) at 6 weeks. Secondary outcomes included perceived improvement, satisfaction and medication use. The co-primary outcomes were modeled with linear mixed effects regression over baseline and weeks 2, 4, 6 and 12.
Mean participant age was 31 years, 23% were female and 32% were non-white. Thirty-eight percent of participants reported acute LBP, 11% sub-acute and 51% chronic. Statistically significant site-by-time-by-group interactions were found in all models, so results are reported by site. Adjusted mean differences in outcomes at week 6 were statistically significant in favor of UMC plus chiropractic care at each site for LBP intensity (Site 1: 0.7, Site 2: 1.2 and Site 3: 1.3), disability (1.7, 2.1 and 2.7), perceived improvement and satisfaction. There were no significant differences in pain medication use. No serious adverse events related to treatment were reported.
Chiropractic care, when added to UMC, resulted in short-term improvements in LBP intensity and disability, demonstrated a low risk of harms, high patient satisfaction and perceived improvement. This trial supports the inclusion of chiropractic care as an effective component of a multi-disciplinary approach for LBP, consistent with newly released guideline recommendations.