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Adding Chiropractic Manipulative Therapy to Standard Medical Care for Patients With Acute Low Back Pain: Results of a Pragmatic Randomized Comparative Effectiveness Study

Goertz, Christine M., DC, PhD*; Long, Cynthia R., PhD*; Hondras, Maria A., DC, MPH*; Petri, Richard, MD; Delgado, Roxana, MS; Lawrence, Dana J., DC, MMedEd, MA§; Owens, Edward F., MS, DC; Meeker, William C., DC, MPH

doi: 10.1097/BRS.0b013e31827733e7
Randomized Trial

Study Design. Randomized controlled trial.

Objective. To assess changes in pain levels and physical functioning in response to standard medical care (SMC) versus SMC plus chiropractic manipulative therapy (CMT) for the treatment of low back pain (LBP) among 18 to 35-year-old active-duty military personnel.

Summary of Background Data. LBP is common, costly, and a significant cause of long-term sick leave and work loss. Many different interventions are available, but there exists no consensus on the best approach. One intervention often used is manipulative therapy. Current evidence from randomized controlled trials demonstrates that manipulative therapy may be as effective as other conservative treatments of LBP, but its appropriate role in the healthcare delivery system has not been established.

Methods. Prospective, 2-arm randomized controlled trial pilot study comparing SMC plus CMT with only SMC. The primary outcome measures were changes in back-related pain on the numerical rating scale and physical functioning at 4 weeks on the Roland-Morris Disability Questionnaire and back pain functional scale (BPFS).

Results. Mean Roland-Morris Disability Questionnaire scores decreased in both groups during the course of the study, but adjusted mean scores were significantly better in the SMC plus CMT group than in the SMC group at both week 2 (P < 0.001) and week 4 (P = 0.004). Mean numerical rating scale pain scores were also significantly better in the group that received CMT. Adjusted mean back pain functional scale scores were significantly higher (improved) in the SMC plus CMT group than in the SMC group at both week 2 (P < 0.001) and week 4 (P = 0.004).

Conclusion. The results of this trial suggest that CMT in conjunction with SMC offers a significant advantage for decreasing pain and improving physical functioning when compared with only standard care, for men and women between 18 and 35 years of age with acute LBP.

Chiropractic manipulative therapy plus standard medical care offers a significant advantage for decreasing pain and improving function compared with only standard medical care for patients aged 18 to 35 years, who have acute low back pain. Further randomized controlled trials are required to establish the appropriate role for chiropractic manipulative therapy in diverse populations in pragmatic settings.

*Palmer Center for Chiropractic Research, Davenport, IA

Physical Medicine and Integrative Care Services, Fort Bliss, TX

Samueli Institute, Alexandria, VA

§Palmer College of Chiropractic, Davenport, IA

TriMax Direct, Saint Paul, MN; and

Palmer College of Chiropractic, San Jose, CA.

Address correspondence and reprint requests to Christine M. Goertz, DC, PhD, Palmer Center for Chiropractic Research, 741 Brady St, Davenport, IA 52803; E-mail:

Acknowledgment date: May 15, 2012. First revision date: August 17, 2012. Acceptance date: September 30, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Samueli Institute grant funds were received to support this work. Some of this work was conducted in a facility constructed with support from Research Facilities Improvement Grant (C06 RR15433) from the National Center for Research Resources, National Institutes of Health.

No relevant financial activities outside the submitted work.

© 2013 Lippincott Williams & Wilkins, Inc.