Low Back Pain

A Comparison of Chiropractic Manipulation Methods and Usual Medical Care for Low Back Pain: A Randomized Controlled Clinical Trial

By Frank M. Painter|June 6, 2014|Chiropractic Care, Low Back Pain, Randomized Controlled Trial|

A Comparison of Chiropractic Manipulation Methods and Usual Medical Care for Low Back Pain: A Randomized Controlled Clinical Trial

SOURCE: J Altern Complement Med. 2014 (May); 20 (5): A22–23

Michael Schneider, Mitchell Haas, Joel Stevans, Ronald Glick, Doug Landsittel

Michael Schneider, mjs5@pitt.edu
University of Pittsburgh, Pittsburgh, PA, USA

Purpose: The primary aim of this study was to compare manual and mechanical methods of spinal manipulation (Activator) for patients with acute and sub-acute low back pain. These are the two most common methods of spinal manipulation used by chiropractors, but there is insufficient evidence regarding their comparative effectiveness against each other. Our secondary aim was to compare both methods with usual medical care.

Methods: In a randomized comparative effectiveness trial, we randomized 107 participants with acute and sub-acute low back pain to: 1) usual medical care; 2) manual side-posture manipulation; and 3) mechanical manipulation (Activator). The primary outcome was self-reported disability (Oswestry) at four weeks. Pain was rated on a 0 to 10 numerical rating scale. Pain and disability scores were regressed on grouping variables adjusted for baseline covariates.

Results: Manual manipulation demonstrated a clinically important and statistically significant reduction of disability and pain compared to Activator (adjusted mean difference=7.9 and 1.3 points respectively, P<.05) and compared to usual medical care (7.0 and 1.8 points respectively, P<.05). There were no significant adjusted mean differences between Activator and usual medical care in disability and pain (0.9 and 0.5 points respectively, P>.05).

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Spinal Manipulation and Exercise for Low Back Painin Adolescents: Study Protocol for a Randomized Controlled Trial

By Frank M. Painter|June 1, 2014|Chiropractic Care, Low Back Pain, Pediatrics|

Spinal Manipulation and Exercise for Low Back Pain in Adolescents: Study Protocol for a Randomized Controlled Trial

The Chiro.Org Blog

SOURCE: Chiropractic & Manual Therapies 2014 (May 23); 22: 21 ~ FULL TEXT

Craig Schulz, Brent Leininger, Roni Evans, Darcy Vavrek, Dave Peterson, Mitchell Haas

and Gert Bronfort

Wolfe-Harris Center for Clinical Studies, Northwestern Health Sciences
University, 2501 W 84th St, Bloomington, MN 55431, USA

Background Low back pain is among the most common and costly chronic health care conditions. Recent research has highlighted the common occurrence of non-specific low back pain in adolescents, with prevalence estimates similar to adults. While multiple clinical trials have examined the effectiveness of commonly used therapies for the management of low back pain in adults, few trials have addressed the condition in adolescents. The purpose of this paper is to describe the methodology of a randomized clinical trial examining the effectiveness of exercise with and without spinal manipulative therapy for chronic or recurrent low back pain in adolescents.

Methods This study is a randomized controlled trial comparing twelve weeks of exercise therapy combined with spinal manipulation to exercise therapy alone. Beginning in March 2010, a total of 184 participants, ages 12 to 18, with chronic or recurrent low back pain are enrolled across two sites. The primary outcome is self-reported low back pain intensity. Other outcomes include disability, quality of life, improvement, satisfaction, activity level, low back strength, endurance, and motion. Qualitative interviews are conducted to evaluate participants’ perceptions of treatment.

Discussion This is the first randomized clinical trial assessing the effectiveness of combining spinal manipulative therapy with exercise for adolescents with low back pain. The results of this study will provide important evidence on the role of these conservative treatments for the management of low back pain in adolescents.

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Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging

By Frank M. Painter|May 6, 2014|Chiropractic Care, Disc Injury, Low Back Pain|

Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging-Confirmed Symptomatic Lumbar Disc Herniations Receiving High-Velocity, Low-Amplitude, Spinal Manipulative Therapy: A Prospective Observational Cohort Study With One-Year Follow-Up

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SOURCE: J Manipulative Physiol Ther 2014 (Mar); 37 (3): 155-163

Serafin Leemann, DC, Cynthia K. Peterson, RN, Christof Schmid, DC, Bernard Anklin, DC, B. Kim Humphreys, DC, PhD

Professor, Chiropractic Medicine and Radiology departments, Orthopaedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland. cynthia.peterson@balgrist.ch

Objective The purposes of this study were to evaluate patients with low-back pain (LBP) and leg pain due to magnetic resonance imaging–confirmed disc herniation who are treated with high-velocity, low-amplitude spinal manipulation in terms of their short-, medium-, and long-term outcomes of self-reported global impression of change and pain levels at various time points up to 1 year and to determine if outcomes differ between acute and chronic patients using a prospective, cohort design.

Methods This prospective cohort outcomes study includes 148 patients (between ages of 18 and 65 years) with LBP, leg pain, and physical examination abnormalities with concordant lumbar disc herniations. Baseline numerical rating scale (NRS) data for LBP, leg pain, and the Oswestry questionnaire were obtained. The specific lumbar spinal manipulation was dependent upon whether the disc herniation was intraforaminal or paramedian as seen on the magnetic resonance images and was performed by a doctor of chiropractic. Outcomes included the patient’s global impression of change scale for overall improvement, the NRS for LBP, leg pain, and the Oswestry questionnaire at 2 weeks, 1, 3, and 6 months, and 1 year after the first treatment. The proportion of patients reporting “improvement” on the patient’s global impression of change scale was calculated for all patients and acute vs chronic patients. Pretreatment and posttreatment NRS scores were compared using the paired t test. Baseline and follow-up Oswestry scores were compared using the Wilcoxon test. Numerical rating scale and Oswestry scores for acute vs chronic patients were compared using the unpaired t test for NRS scores and the Mann-Whitney U test for Oswestry scores. Logistic regression analysis compared baseline variables with “improvement.”

Results Significant improvement for all outcomes at all time points was reported (P < .0001). At 3 months, 90.5% of patients were “improved” with 88.0% “improved” at 1 year. Although acute patients improved faster by 3 months, 81.8% of chronic patients reported “improvement” with 89.2% “improved” at 1 year. There were no adverse events reported.

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The Comparative Effect of Episodes of Chiropractic and Medical Treatment on the Health of Older Adults

By Frank M. Painter|April 29, 2014|Low Back Pain, Medicare|

The Comparative Effect of Episodes of Chiropractic and Medical Treatment on the Health of Older Adults

The Chiro.Org Blog

SOURCE: J Manipulative Physiol Ther 2014 (Mar); 37 (3): 143–154

Paula A Weigel, Jason Hockenberry, PhD,
Suzanne E. Bentler, PhD, Fredric D. Wolinsky, PhD

Candidate for PhD,
Department of Health Management and Policy,
College of Public Health,
The University of Iowa,
Iowa City, IA.

OBJECTIVES: The comparative effect of chiropractic vs medical care on health, as used in everyday practice settings by older adults, is not well understood. The purpose of this study is to examine how chiropractic compares to medical treatment in episodes of care for uncomplicated back conditions. Episodes of care patterns between treatment groups are described, and effects on health outcomes among an older group of Medicare beneficiaries over a 2-year period are estimated.

METHODS: Survey data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old were linked to participants’ Medicare Part B claims under a restricted Data Use Agreement with the Centers for Medicare and Medicaid Services. Logistic regression was used to model the effect of chiropractic use in an episode of care relative to medical treatment on declines in function and well-being among a clinically homogenous older adult population. Two analytic approaches were used, the first assumed no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS: Episodes of care between treatment groups varied in duration and provider visit pattern. Among the unadjusted models, there was no significant difference between chiropractic and medical episodes of care. The propensity score results indicate a significant protective effect of chiropractic against declines in activities of daily living (ADLs), instrumental ADLs, and self-rated health (adjusted odds ratio [AOR], 0.49; AOR, 0.62; and AOR, 0.59, respectively). There was no difference between treatment types on declines in lower body function or depressive symptoms.

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A Randomized Controlled Trial Comparing A Multimodal Intervention and Standard Obstetrics Care For Low Back and Pelvic Pain In Pregnancy

By Frank M. Painter|April 5, 2014|Chiropractic Care, Low Back Pain, Pregnancy|

A Randomized Controlled Trial Comparing A Multimodal Intervention and Standard Obstetrics Care For Low Back and Pelvic Pain In Pregnancy

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SOURCE: Am J Obstet Gynecol. 2013 (Apr); 208 (4): 295. e1-7

James W. George, DC; Clayton D. Skaggs, DC;
Paul A. Thompson, PhD; D. Michael Nelson, MD, PhD;
Jeffrey A. Gavard, PhD; Gilad A. Gross, MD

Chiropractic Science Division,
College of Chiropractic,
Logan University, Chesterfield, MO, USA

OBJECTIVE: Women commonly experience low back pain during pregnancy. We examined whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to reduce pain, impairment, and disability in the antepartum period.

STUDY DESIGN: A prospective, randomized trial of 169 women was conducted. Baseline evaluation occurred at 24-28 weeks’ gestation, with follow-up at 33 weeks’ gestation. Primary outcomes were the Numerical Rating Scale (NRS) for pain and the Quebec Disability Questionnaire (QDQ). Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants.

RESULTS: The MOM group demonstrated significant mean reductions in Numerical Rating Scale scores (5.8 ± 2.2 vs 2.9 ± 2.5; P < .001) and Quebec Disability Questionnaire scores (4.9 ± 2.2 vs 3.9 ± 2.4; P < .001) from baseline to follow-up evaluation. The group that received standard obstetric care demonstrated no significant improvements.

CONCLUSION: A multimodal approach to low back and pelvic pain in mid pregnancy benefits patients more than standard obstetric care.

From the Full-Text Article:

Introduction

Musculoskeletal pain in pregnant women commonly is viewed as transient, physiologic, and self-limited. However, most women report either low back pain (LBP) or pelvic pain (PP) during pregnancy [1-6] and the morbidity that is associated with such complaints. [7, 8] Moreover, up to 40% of patients report musculoskeletal pain during the 18 months after delivery, [2, 7, 9, 10] and one-fifth of these women have severe LBP that leads to major personal, social, or economic problems. [7, 9, 11] Pregnancy-related LBP contributes substantially to health care costs. For example, one-fifth of pregnant women in Scandinavian countries experience back pain as an indication for up to 7 weeks of sick leave in the perinatal period. [7, 9] Ninety-four percent of women who experienced LBP in an index pregnancy have recurrent symptoms with subsequent pregnancy, and two-thirds of these patients experience disability and require sick leave during pregnancy. Notably, 19% of women with pain in an initial pregnancy report avoidance of a future pregnancy out of fear of recurrence of the musculoskeletal symptoms. [11]

Most past investigations that have evaluated interventions to reduce morbidity in women with LBP/PP during pregnancy have used modalities that have included prescription exercise, [12] manual manipulation, [13] education, [14] acupuncture, [15] or pelvic belts. [16] Recently, a multimodal randomized trial compared osteopathic manipulation to usual obstetric care and sham ultrasonic therapy on 144 participants. [13] Importantly, this trial did not include behavioral and exercise therapies. We conducted a prospective, randomized, masked clinical trial to test the hypothesis that a multimodal approach of manual therapy, exercise, and education for LBP/PP in pregnant women is superior to standard obstetric care (STOB) for the reduction of pain, impairment, and disability in the ante-partum period.

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Outcomes Of Pregnant Patients With Low Back Pain Undergoing Chiropractic Treatment: A Prospective Cohort Study With Short Term, Medium Term and 1 Year Follow-up

By Frank M. Painter|April 4, 2014|Chiropractic Care, Low Back Pain, Pregnancy|

Outcomes Of Pregnant Patients With Low Back Pain Undergoing Chiropractic Treatment: A Prospective Cohort Study With Short Term, Medium Term and 1 Year Follow-up

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SOURCE: Chiropractic & Manual Therapies 2014 (Apr 1); 22 (1): 15 ~ FULL TEXT

Cynthia K Peterson, Daniel Mühlemann,
Barry Kim Humphreys

Department of Chiropractic Medicine,
Orthopaedic University Hospital Balgrist,
University of Zürich,
Forchstrasse 340, Zürich, Switzerland

BACKGROUND: Low back pain in pregnancy is common and research evidence on the response to chiropractic treatment is limited. The purposes of this study are 1) to report outcomes in pregnant patients receiving chiropractic treatment; 2) to compare outcomes from subgroups; 3) to assess predictors of outcome.

METHODS: Pregnant patients with low back or pelvic pain, no contraindications to manipulative therapy and no manual therapy in the prior 3 months were recruited.Baseline numerical rating scale (NRS) and Oswestry questionnaire data were collected. Duration of complaint, number of previous LBP episodes, LBP during a previous pregnancy, and category of pain location were recorded.The patient’s global impression of change (PGIC) (primary outcome), NRS, and Oswestry data (secondary outcomes) were collected at 1 week, 1 and 3 months after the first treatment. At 6 months and 1 year the PGIC and NRS scores were collected. PGIC responses of ‘better or ‘much better’ were categorized as ‘improved’.The proportion of patients ‘improved’ at each time point was calculated. Chi-squared test compared subgroups with ‘improvement’. Baseline and follow-up NRS and Oswestry scores were compared using the paired t-test. The unpaired t-test compared NRS and Oswestry scores in patients with and without a history of LBP and with and without LBP during a previous pregnancy. Anova compared baseline and follow-up NRS and Oswestry scores by pain location category and category of number of previous LBP episodes. Logistic regression analysis also was also performed.

RESULTS: 52% of 115 recruited patients ‘improved’ at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year. There were significant reductions in NRS and Oswestry scores (p < 0.0005). Category of previous LBP episodes number at one year (p = 0.02) was related to ‘improvement’ when analyzed alone, but was not strongly predictive in logistic regression. Patients with more prior LBP episodes had higher 1 year NRS scores (p = 0.013).

CONCLUSIONS: Most pregnant patients undergoing chiropractic treatment reported clinically relevant improvement at all time points. No single variable was strongly predictive of ‘improvement’ in the logistic regression model.

From the Full-Text Article:

Background

Low back and pelvic pain in pregnant women is such a common phenomenon that it is often considered a normal part of the pregnancy [1-3]. However, the high prevalence of this problem (50-80% of women) and the impact that this may have on their quality of life, as well as the fact that back pain during pregnancy is commonly linked to low back pain persisting after pregnancy, mandates that it be taken seriously by health care practitioners [1-6]. Many of these patients rate their back pain as moderate to severe with a small percentage claiming to be significantly disabled by the pain [6-8].

Pregnancy-related low back pain is most often divided into 3 categories based on location. These are: lumbar spine pain (LP), posterior pelvic pain (PPP), or a combination of these two [1, 2, 9], with posterior pelvic pain reported to be the most common presentation [1, 10] and the location most specific for pregnant patients [9]. However, other authors have used 4 categories for pelvic only pain, including anterior pain at the pubic symphysis (symphysiolysis) but excluding lumbar spine pain [11].

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