Amount of Health Care and Self-care Following a Randomized Clinical Trial Comparing Flexion-distraction with Exercise Program for Chronic Low Back Pain
SOURCE: Chiropractic & Osteopathy 2006 (Aug 24); 14: 19
Jerrilyn A Cambron, M Ram Gudavalli,
Marion McGregor, James Jedlicka,
Michael Keenum, Alexander J Ghanayem,
Avinash G Patwardhan and Sylvia E Furner
Department of Research,
National University of Health Sciences,
Lombard, IL, USA.
BACKGROUND: Previous clinical trials have assessed the percentage of participants who utilized further health care after a period of conservative care for low back pain, however no chiropractic clinical trial has determined the total amount of care during this time and any differences based on assigned treatment group. The objective of this clinical trial follow-up was to assess if there was a difference in the total number of office visits for low back pain over one year after a four week clinical trial of either a form of physical therapy (Exercise Program) or a form of chiropractic care (Flexion Distraction) for chronic low back pain.
METHODS: In this randomized clinical trial follow up study, 195 participants were followed for one year after a four-week period of either a form of chiropractic care (FD) or a form of physical therapy (EP). Weekly structured telephone interview questions regarded visitation of various health care practitioners and the practice of self-care for low back pain.
RESULTS: Participants in the physical therapy group demonstrated on average significantly more visits to any health care provider and to a general practitioner during the year after trial care (p < 0.05). No group differences were noted in the number of visits to a chiropractor or physical therapist. Self-care was initiated by nearly every participant in both groups.
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CONCLUSION: During a one-year follow-up, participants previously randomized to physical therapy attended significantly more health care visits than those participants who received chiropractic care.
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Background
People impaired with back pain frequently seek help from medical professionals. In 1999, there were about 15 million office visits to physicians in the U.S. for low back pain, accounting for about 2.8% of all office visits. Because this number did not include visits to other health care professionals, such as chiropractors, the actual number of office visits was probably more than 30 million per year. [1] Health care expenditures related to back pain reached $26.3 billion in 1998 in the United States alone. [2] Feuerstein et al. assessed the 1997 National Medical Expenditure Panel Survey, and determined that of the participants with low back pain, the majority sought medical management (73.7%), chiropractic care (30.6%), or physical therapy (9.3%). [3] Within this low back pain population, the average number of visits per year was 3.8 medical visits, 7.8 chiropractic visits, and 8.4 physical therapy visits. [3] These results give us an idea of the health care utilized by individuals in the general population who suffer with low back pain.
Care seeking behavior by patients with low back pain is most commonly associated with increased pain and disability [4-6], meaning more care is sought when worse symptoms are experienced. The amount of health care utilized may therefore be used as a measure of patient health status, and thus may be compared between groups of patients to determine effectiveness of certain therapies. The purpose of this study is to assess if there is a difference in the total annual number of office visits for low back pain after a four-week clinical trial of either chiropractic care (flexion distraction) or physical therapy (exercise program) for treatment of chronic low back pain.
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