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

Details

• Personal Author:
  Adams AH ; Belin TR ; Harber P ; Hurwitz EL ; Kominski GF ; Morgenstern H ; Yu F
• Description:
  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. [Description provided by NIOSH]
• Subjects:
  Musculoskeletal Diseases Musculoskeletal System Occupational Health Safety
• Keywords:
  Author Keywords: Low Back Pain Chiropractic Clinical Techniques Low Back Pain Managed Care Medical Treatment MSD Musculoskeletal Disorders Physical Therapy Randomized Controlled Trial
• ISSN:
  0161-4754
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  10-20
• Volume:
  25
• Issue:
  1
• NIOSHTIC Number:
  nn:20058262
• Citation:
  J Manipulative Physiol Ther 2002 Jan; 25(1):10-20
• Contact Point Address:
  Eric L. Hurwitz, DC, PhD, UCLA School of Public Health, Department of Epidemiology, Box 951772, Los Angeles, CA 90095-1772, USA
• Email:
  ehurwitz@ucla.edu
• Federal Fiscal Year:
  2002
• Performing Organization:
  University of California, School of Public Health, Los Angeles, California
• Peer Reviewed:
  True
• Start Date:
  19990701
• Source Full Name:
  Journal of Manipulative and Physiological Therapeutics
• End Date:
  20040630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:69dab5e343f1c177409e02e829be65dcab9ac4362258fcbac1505c36ad3359e4f42dcc2aeec371b82367bebcfbe5db16afb1f309ecc61cd8f7c016bfb9a39c8a
• Download URL:
  https://stacks.cdc.gov/view/cdc/221392/cdc_221392_DS1.pdf
• File Type:
  [PDF - 205.40 KB ]