A randomized clinical trial.
To compare the effectiveness of medical and chiropractic care for low back pain patients in managed care; to assess the effectiveness of physical therapy among medical patients; and to assess the effectiveness of physical modalities among chiropractic patients.
Despite the burden that low back pain places on patients, providers, and society, the relative effectiveness of common treatment strategies offered in managed care is unknown.
Low back pain patients presenting to a large managed care facility from October 30, 1995, through November 9, 1998, were randomly assigned in a balanced design to medical care with and without physical therapy and to chiropractic care with and without physical modalities. The primary outcome variables are average and most severe low back pain intensity in the past week, assessed with 0 to 10 numerical rating scales, and low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire.
Of 1,469 eligible patients, 681 were enrolled; 95.7% were followed through 6 months. The mean changes in low back pain intensity and disability of participants in the medical and chiropractic care-only groups were similar at each follow-up assessment (adjusted mean differences at 6 months for most severe pain, 0.27, 95% confidence interval, -0.32–0.86; average pain, 0.22, -0.25–0.69; and disability, 0.75, -0.29–1.79). Physical therapy yielded somewhat better 6-month disability outcomes than did medical care alone (1.26, 0.20–2.32).
After 6 months of follow-up, chiropractic care and medical care for low back pain were comparable in their effectiveness. Physical therapy may be marginally more effective than medical care alone for reducing disability in some patients, but the possible benefit is small.
From the *Department of Epidemiology, University of California–Los Angeles (UCLA) School of Public Health, Los Angeles, California; the †Southern California University of Health Sciences, Whittier, California; the ‡UCLA School of Medicine, Los Angeles, California; and the §Department of Health Services and the ∥Department of Biostatistics, UCLA School of Public Health.
This study was funded by grants from the Agency for Healthcare Research and Quality (AHRQ) (R01 HS07755) and the Southern California University of Health Sciences. Dr. Hurwitz was supported by a grant from the National Center for Complementary and Alternative Medicine (NCCAM) (K23 AT00055).
Acknowledgment date: October 8, 2001.
First revision date: January 23, 2002.
Acceptance date: April 10, 2002.
Address reprint requests to
Eric L. Hurwitz, DC, PhD
UCLA School of Public Health
Department of Epidemiology
Los Angeles, CA 90095-1772
Device status/drug statement: This report does not contain information about medical device(s)drug(s).
Conflict of interest: Federal and foundation funds were received to support this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this report.