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Low Back Pain

Association Between Spinal Manipulative Therapy and Lumbar Spine Reoperation After Discectomy: A Retrospective Cohort Study

By |February 18, 2024|Failed Back Surgery Syndrome, Low Back Pain, Lumbosacral Radiculopathy|

Association Between Spinal Manipulative Therapy and Lumbar Spine Reoperation After Discectomy: A Retrospective Cohort Study

The Chiro.Org Blog

SOURCE:   BMC Musculoskelet Disord 2024 (Jan 10); 25 (1): 46
Robert J. Trager, Jordan A. Gliedt Collin M. Labak,Clinton J. Daniels, and Jeffery A. Dusek

Connor Whole Health,
University Hospitals Cleveland Medical Center,
Cleveland, OH, USA.

Background:   Patients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms. We hypothesized that adults receiving SMT for LSR at least one year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over two years’ follow-up.

Methods:   We searched a United States network of health records (TriNetX, Inc.) for adults aged ≥ 18 years with LSR and lumbar discectomy ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023. We divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT. We used propensity matching to adjust for confounding variables associated with lumbar spine reoperation (e.g., age, body mass index, nicotine dependence), calculated risk ratios (RR), with 95% confidence intervals (CIs), and explored cumulative incidence of reoperation and the number of SMT follow-up visits.

Results:   Following propensity matching there were 378 patients per cohort (mean age 61 years). Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort (SMT: 7%; usual care: 13%), yielding an RR (95% CIs) of 0.55 (0.35-0.85; P = 0.0062). In the SMT cohort, 72% of patients had ≥ 1 follow-up SMT visit (median = 6).

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Global, Regional, and National Burden of Low Back Pain, 1990–2020, Its Attributable Risk Factors,
and Projections to 2050: A Systematic Analysis of the Global Burden of Disease Study 2021

By |May 24, 2023|Global Burden of Disease, Global Spine Care Initiative, Low Back Pain|

Global, Regional, and National Burden of Low Back Pain, 1990–2020, Its Attributable Risk Factors, and Projections to 2050: A Systematic Analysis of the Global Burden of Disease Study 2021

The Chiro.Org Blog

SOURCE:   Lancet Rheumatology 2023 (May 23); 5 (6): E316-E329
Manuela L Ferreira, Katie de Luca, Lydia M Haile, Jaimie D Steinmetz, Garland T Culbreth, et al.

Faculty of Medicine and Health,
Institute of Bone and Joint Research,
The Kolling Institute, Northern Clinical School,
University of Sydney,
Sydney, NSW 2064, Australia.

Background   Low back pain is highly prevalent and the main cause of years lived with disability (YLDs). We present the most up-to-date global, regional, and national data on prevalence and YLDs for low back pain from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021.

Methods   Population-based studies from 1980 to 2019 identified in a systematic review, international surveys, US medical claims data, and dataset contributions by collaborators were used to estimate the prevalence and YLDs for low back pain from 1990 to 2020, for 204 countries and territories. Low back pain was defined as pain between the 12th ribs and the gluteal folds that lasted a day or more; input data using alternative definitions were adjusted in a network meta-regression analysis. Nested Bayesian meta-regression models were used to estimate prevalence and YLDs by age, sex, year, and location. Prevalence was projected to 2050 by running a regression on prevalence rates using Socio-demographic Index as a predictor, then multiplying them by projected population estimates.

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Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims

By |April 29, 2023|Chiropractic Management, Initial Provider, Low Back Pain|

Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims

The Chiro.Org Blog

SOURCE:   J Manipulative Physiol Ther 2021 (Nov); 44 (9): 683–689
Brian R. Anderson, DC, MPH, MS, PhD, Steve W. McClellan, MS

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
Davenport, IA.


FROM:  
Houweling, JMPT 2015    Liliedahl, JMPT 2010

Objective:   The purpose of this study was to evaluate the relationship between procedures and care patterns in back pain episodes by analyzing health insurance claims.

Methods:   We performed a retrospective cohort study of insurance claims data from a single Fortune 500 company. The 3 care patterns we analyzed were initial spinal manipulative therapy, delayed spinal manipulative therapy, and no spinal manipulative therapy. The 3 procedures analyzed were imaging studies, injection procedures, and back surgery. We considered “escalated care” to be any claims with diagnostic imaging, injection procedures, or back surgery. Modified-Poisson regression modeling was used to determine relative risk of escalated care.

Results:   There were 83,025 claims that were categorized into 10 372 unique patient first episodes. Spinal manipulative therapy was present in 2,943 episodes (28%). Initial spinal manipulation was present in 2,519 episodes (24%), delayed spinal manipulation was present in 424 episodes (4%), and 7,429 (72%) had no evidence of spinal manipulative therapy. The estimated relative risk, adjusted for age, sex, and risk score, for care escalation (eg, imaging, injections, or surgery) was 0.70 (95% confidence interval 0.65–0.75, P < .001) for initial spinal manipulation and 1.22 (95% confidence interval 1.10–1.35, P < .001) for delayed spinal manipulation with no spinal manipulation used as the reference group.

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Spinal Pain, Chronic Health Conditions and Health Behaviors: Data from the 2016-2018 National Health Interview Survey

By |April 16, 2023|Chronic Neck Pain, Chronic Spinal Pain, Low Back Pain|

Spinal Pain, Chronic Health Conditions and Health Behaviors: Data from the 2016-2018 National Health Interview Survey

The Chiro.Org Blog

SOURCE:   Int J Environ Res Public Health 2023 (Apr 3); 20 (7): 5369

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Katie de Luca, Patricia Tavares, Haiou Yang, Eric L Hurwitz, Bart N Green, Hannah Dale, Scott Haldeman

Discipline of Chiropractic,
School of Health, Medical and Applied Science,
CQ University,
Brisbane, QLD 4701, Australia.


FROM:   J Pain Res. 2021

Spinal pain and chronic health conditions are highly prevalent, burdensome, and costly conditions, both in the United States and globally. Using cross-sectional data from the 2016 through 2018 National Health Interview Survey (n = 26,926), we explored associations between spinal pain and chronic health conditions and investigated the influence that a set of confounders may have on the associations between spinal pain and chronic health conditions. Variance estimation method was used to compute weighted descriptive statistics and measures of associations with multinomial logistic regression models. All four chronic health conditions significantly increased the prevalence odds of spinal pain; cardiovascular conditions by 58%, hypertension by 40%, diabetes by 25% and obesity by 34%, controlling for all the confounders.

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The Perceived Barriers and Facilitators for Chiropractic Care in Older Adults with Low Back Pain; Insights from a Qualitative Exploration in a Dutch Context

By |April 13, 2023|Chiropractic Management, Low Back Pain, Medicare|

The Perceived Barriers and Facilitators for Chiropractic Care in Older Adults with Low Back Pain; Insights from a Qualitative Exploration in a Dutch Context

The Chiro.Org Blog

SOURCE:   PLoS One 2023 (Apr 12); 18 (4): e0283661

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Lobke P. De la Ruelle, Annemarie de Zoete, Cornelius Myburgh, Hella E. Brandt, Sidney M. Rubinstein

Department of Health Sciences,
Faculty of Science,
Amsterdam Movement Sciences,
Vrije Universiteit Amsterdam,
Amsterdam, The Netherlands.

Background:   Understanding care seeking behaviour is vital to enabling access to care. In the context of low back pain (LBP), chiropractors offer services to patients of all ages. Currently, geriatric sub-populations tend to be under-investigated, despite the disproportionate effects of LBP on older adults. In the Netherlands, the chiropractic profession is relatively unknown and therefore, generally speaking, is not considered as the first choice for conservative musculoskeletal primary health care. The aim of this paper was to explore the experiences of older adults with LBP, seeking chiropracic care for the first time, in order to identify perceived barriers and facilitators in this process.

Methods:   Stage 1: Participants 56 years of age and older with chronic LBP who either sought or did not seek chiropractic care were interviewed to provide detailed information on the factors that promoted or impeded care-seeking behaviour. A purposive sampling strategy was used to recruit participants through a network of researchers, chiropractors and other healthcare professionals offering musculoskeletal health care services. Individuals with underlying pathology, previous surgery for LBP, or insufficient mastery of the Dutch language were excluded. Data were collected until saturation was reached and thematically analysed. Stage 2: To further explore the themes, a focus group interview was conducted with a provider stakeholder group consisting of:two physiotherapists, a nurse practitioner, a geriatrician, and a chiropractor. All interviews were conducted online, voice recorded, and transcribed verbatim.

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Treatment Targets of Exercise for Persistent Non-specific Low Back Pain: A Consensus Study

By |March 24, 2023|Chiropractic Management, Exercise and Chiropractic, Low Back Pain|

Treatment Targets of Exercise for Persistent Non-specific Low Back Pain: A Consensus Study

The Chiro.Org Blog

SOURCE:   Physiotherapy 2021 (Sep); 112: 78–86
Lianne Wood, Annette Bishop, Martyn Lewis, Rob J E M Smeets, Gert Bronfort, Jill A Hayden, Nadine E Foster

Primary Care Centre Versus Arthritis,
School of Primary, Community and Social Care,
Faculty of Medicine and Health Sciences,
Keele University,
Newcastle-under-Lyme ST5 5BG, UK


FROM:   Br J Sports Med 2020

Objectives:   Despite several hundred previous randomised controlled trials (RCTs), the key treatment targets of exercise for persistent non-specific low back pain (NSLBP) remain unclear. This study aimed to generate consensus about the key treatment targets of exercise interventions for patients with NSLBP.

Design:   Consensus was generated using modified nominal group technique in two, sequential, workshops. The results of a previous systematic review informed the first, national, workshop idea generation and the results of this workshop informed the second, international, workshop. The authors generated a starting list of 30 treatment targets from the systematic review. A pre-specified consensus threshold of 75% was used in the voting stage.

Participants:   Workshop participants included people with experience of using exercise to manage their persistent NSLBP, clinicians who prescribe exercise for persistent NSLBP, and researchers who design and evaluate exercise interventions in RCTs. All participants generated, voted and ranked the treatment targets in each workshop using an online platform.

Results:   A total of 39 participants contributed to the consensus (15 in the national workshop and 24 in the international workshop), comprising two people with NSLBP, six clinicians and 31 researchers/clinicians. A total of 40 exercise treatment targets were generated, and 25 were retained after voting and ranking. The prioritised targets of exercise for persistent NSLBP were: improving function, improving quality of life, reducing pain, meeting patient-specific goals and reducing fear of movement.

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