Exploring the Definition of Acute Low Back Pain: A Prospective Observational Cohort Study Comparing Outcomes of Chiropractic Patients With 0-2, 2-4, and 4-12 Weeks of Symptoms
SOURCE: J Manipulative Physiol Ther. 2016 (Mar); 39 (3): 141–149
Karin E. Mantel, MChiroMed,
Cynthia K. Peterson, RN, DC, MMedEd, and
B. Kim Humphreys, DC, PhD
Chiropractic Medicine Doctoral Student,
Chiropractic Medicine Department,
Faculty of Medicine,
University of Zürich, Switzerland.
OBJECTIVE: The purpose of this study was to compare improvement rates in patients with low back pain (LBP) undergoing chiropractic treatment with 0-2 weeks vs 2-4 and 4-12 weeks of symptoms.
METHODS: This was a prospective cohort outcome study with 1-year follow-up including adult acute (symptoms 0-4 weeks) LBP patients. The numerical rating scale for pain (NRS) and Oswestry questionnaire were completed at baseline, 1 week, 1 month, and 3 months after starting treatment. The Patient Global Impression of Change (PGIC) scale was completed at all follow-up time points. At 6 months and 1 year, NRS and PGIC data were collected. The proportion of patients reporting relevant “improvement” (PGIC scale) was compared between patients having 0-2 and 2-4 weeks of symptoms using the χ2 test at all data collection time points. The unpaired t test compared NRS and Oswestry change scores between these 2 groups.
RESULTS: Patients with 0-2 weeks of symptoms were significantly more likely to “improve” at 1 week, 1 month, and 6 months compared with those with 2-4 weeks of symptoms (P < .015). Patients with 0-2 weeks of symptoms reported significantly higher NRS and Oswestry change scores at all data collection time points. Outcomes for patients with 2-4 weeks of symptoms were similar to patients having 4-12 weeks of symptoms.
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CONCLUSION: The time period 0-4 weeks as the definition of “acute” should be challenged. Patients with 2-4 weeks of symptoms had outcomes similar to patients with subacute (4-12 weeks) symptoms and not with patients reporting 0-2 weeks of symptoms.
KEYWORDS: Chiropractic; Low Back Pain; Treatment Outcome
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Introduction
Mechanical, nonspecific low back pain (LBP) remains a very common condition in developed countries. Low back pain in general has a point prevalence between 15% and 30%. [1] For the individual, it means a painful dysfunction with a lifetime prevalence of about 70%. [1] From these patients, it has been stated that two-thirds do not completely recover after 1 year [2] and 7.7% develop chronic pain. [3, 4] Furthermore, not only is this a problem in terms of the individual suffering, but also their social environment and workplace have to bear their burden. For the industrialized countries, LBP is one of the most costly conditions and makes up a considerable amount of our health care costs. Bevan et al [5] estimated that approximately CHF 2-4 billion per year is spent for all musculoskeletal disorders in Switzerland, where LBP is a large part of this total sum. A German study calculated an average annual cost for an LBP patient of €1322. [6] These costs are divided into direct costs (46%) [6] by using health care services such as therapeutic procedures, rehabilitation, and hospital and indirect costs (54%) [1, 6] due to work absenteeism and early retirement. [7] With ongoing duration of symptoms, indirect costs rise, and therefore, mean costs for a chronic LBP patient are twice as high as those for an acute patient. [1] In addition, there are also nonfinancial costs including losing participation in social activities and family.
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