How Does Chiropractic Care Measure Against Other Types of Conservative Treatment for Low Back Pain?There have been quite a few studies showing that chiropractic care (specifically spinal manipulation) is effective for the treatment of acute low back pain. But there aren't too many patients who go to the chiropractor and only have a single spinal manipulation (often called an adjustment).
In this study, the type of combined treatment really received in a chiropractic clinic is the focus. Combined treatment refers to the spinal manipulation along with patient education, massage, heat or cold, exercises, bracing, and pillows. Advice on nutrition and lifestyle changes are also part of the patient education piece.
Does combined treatment work as well (or possibly better) than spinal manipulation alone? How does chiropractic care compare with other interventions? What short-, mid-, and long-term outcomes are seen with combined care? Are there any adverse effects of combined chiropractic care? And finally, how do the results of chiropractic care compare with having no treatment?
To make these comparisons, the researchers had to find studies that used the same or similar time frame and outcome measures. Short-term results were measured during the first month after treatment was started. Medium-term follow-up included results obtained between one and six months after the start of treatment. Long-term refers to anything achieved six month after treatment began (or later).
Pain, disability, and general health status were used to measure progress. Studies included in the analysis had to describe patients in such a way that comparisons could be made between studies. The treatment or plan of care used had to be clear enough to make the same type of comparisons from one study to the next.
This criteria was met in 12 of the studies reviewed. There was a total of 2887 low back pain patients in those 12 studies. Each study was a randomized controlled trial (RCT) meaning patients were assigned to treatment groups randomly (usually generated by a computer).
A special table summarizing all the information gathered is presented. You can look at this table and see at a glance the type of chiropractic care given in each study. Treatment given for each of the other groups (compared with the chiropractic care) was placed in the adjacent columns.
After collecting all the data from the 12 studies and making comparisons, there simply wasn't a significant or measurable difference in results between combined chiropractic care and other interventions when used alone. Other interventions included heat, cold, massage, education, medications, bed rest, and exercise.
Some patients got pain relief faster in the chiropractic care group at the start (short-term) but the improvement in pain over other treatment wasn't considered statistically significant. At the end (long-term), this edge was no longer present. That's pain, what about disability? Same story: no significant difference in disability at any point between combined chiropractic care and other treatment approaches.
The final outcome measure (general health) was no different between combined chiropractic care and other types of care in the short- and mid-term. Long-term results weren't available in any of the studies published so far. That leaves rate of improvement and adverse effects.
Once again, no difference in rate of improvement in the short-, mid-, or long-term. And no major or serious adverse effects of chiropractic care were reported. There were some cases of increased pain and other symptoms with chiropractic care but nothing was permanent or lasted more than a few hours to a few days.
In summary, according to this systematic review, chiropractic care does not provide any long-term benefit over other types of conservative care in terms of pain relief, disability, or general health. Whether or not chiropractic care is better than no treatment has not been explored yet. This would be an important area of future study along with using return-to-work or daily activities as specific functional measures.
This review studied how treatment (mixed therapies) is typically delivered in a chiropractic clinic. But it didn't help determine if one modality would work better than another or if all are truly needed to get the desired results. The studies included did not look at subgroups of patients (i.e., treat groups of patients differently because of specific characteristics). That's another area for future research.
Bruce F. Walker, DC, MPH, DrPH, et al. A Cochrane Review of Combined Chiropractic Interventions for Low Back Pain. In Spine. February 1, 2011. Vol. 36. No. 3. Pp. 230-242.
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