A Randomized Trial of Medical Care with and Without Physical Therapy and Chiropractic Care with and Without Physical Modalities for Patients with Low Back Pain: 6-Month Follow-Up Outcomes from the UCLA Low Back Pain Study

Details

• Personal Author:
  Adams AH ; Belin TR ; Harber P ; Hurwitz EL ; Kominski GF ; Morgenstern H ; Yu F ; Adams AH ; Belin TR ; Harber P ; Hurwitz EL ; Kominski GF ; Morgenstern H ; Yu F
• Description:
  Study Design. A randomized clinical trial. Objectives. To compare the effectiveness of medical and chiropractic care for low back pain patients in managed care; to assess the effectiveness of physical therapy among medical patients; and to assess the effectiveness of physical modalities among chiropractic patients. Summary of Background Data. Despite the burden that low back pain places on patients, providers, and society, the relative effectiveness of common treatment strategies offered in managed care is unknown. Methods. Low back pain patients presenting to a large managed care facility from October 30, 1995, through November 9, 1998, were randomly assigned in a balanced design to medical care with and without physical therapy and to chiropractic care with and without physical modalities. The primary outcome variables are average and most severe low back pain intensity in the past week, assessed with 0 to 10 numerical rating scales, and low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire. Results. Of 1,469 eligible patients, 681 were enrolled; 95.7% were followed through 6 months. The mean changes in low back pain intensity and disability of participants in the medical and chiropractic care-only groups were similar at each follow-up assessment (adjusted mean differences at 6 months for most severe pain, 0.27, 95% confidence interval, -0.32-0.86; average pain, 0.22, -0.25-0.69; and disability, 0.75, -0.29-1.79). Physical therapy yielded somewhat better 6-month disability outcomes than did medical care alone (1.26, 0.20-2.32). Conclusions. After 6 months of follow-up, chiropractic care and medical care for low back pain were comparable in their effectiveness. Physical therapy may be marginally more effective than medical care alone for reducing disability in some patients, but the possible benefit is small. [Description provided by NIOSH]
• Subjects:
  Delivery Of Health Care Musculoskeletal Diseases Musculoskeletal System Occupational Health Safety
• Keywords:
  Clinical Techniques Low Back Pain Medical Care Medical Treatment MSD Musculoskeletal Disorders Physical Therapy
• ISSN:
  0362-2436
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article ; Journal Article
• Place as Subject:
  California ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH) ; National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health ; Workplace Safety & Health
• Location:
  North America ; North America
• Volume:
  27
• Issue:
  20
• NIOSHTIC Number:
  nn:20058298
• Citation:
  Spine 2002 Oct; 27(20):2193-2204
• Contact Point Address:
  Eric L. Hurwitz, DC, PhD, UCLA School of Public Health, Department of Epidemiology, Box 951772, Los Angeles, CA 90095-1772
• Email:
  ehurwitz@ucla.edu
• Federal Fiscal Year:
  2003
• Performing Organization:
  University of California, School of Public Health, Los Angeles, California
• Peer Reviewed:
  False
• Start Date:
  19990701
• Source Full Name:
  Spine
• End Date:
  20040630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:63c5e0fdf899c13e877b059d90e32f3b6699a8138a546601dd2e1c65a9e26b81c8c6bb74358da76fd35404dd6576b3a76885280437d1e0d2fd50aa42a65bfac2
• Download URL:
  https://stacks.cdc.gov/view/cdc/221425/cdc_221425_DS1.pdf
• File Type:
  [PDF - 677.93 KB ]