A COMPARISON OF PHYSICAL THERAPY, CHIROPRACTIC MANIPULATION, AND PROVISION OF AN EDUCATIONAL BOOKLET FOR THE TREATMENT OF PATIENTS WITH LOW-BACK-PAIN

Citation
Dc. Cherkin et al., A COMPARISON OF PHYSICAL THERAPY, CHIROPRACTIC MANIPULATION, AND PROVISION OF AN EDUCATIONAL BOOKLET FOR THE TREATMENT OF PATIENTS WITH LOW-BACK-PAIN, The New England journal of medicine, 339(15), 1998, pp. 1021-1029
Citations number
33
Categorie Soggetti
Medicine, General & Internal
ISSN journal
00284793
Volume
339
Issue
15
Year of publication
1998
Pages
1021 - 1029
Database
ISI
SICI code
0028-4793(1998)339:15<1021:ACOPTC>2.0.ZU;2-0
Abstract
Background and Methods There are few data on the relative effectivenes s and costs of treatments for low back pain. We randomly assigned 321 adults with low back pain that persisted for seven days after a primar y care visit to the McKenzie method of physical therapy, chiropractic manipulation, or a minimal intervention (provision of an educational b ooklet). Patients with sciatica were excluded. Physical therapy or chi ropractic manipulation was provided for one month (the number of visit s was determined by the practitioner but was limited to a maximum of n ine); patients were followed for a total of two years. The bothersomen ess of symptoms was measured on an 11-point scale, and the level of dy sfunction was measured on the 24-point Roland Disability Scale. Result s After adjustment for base-line differences, the chiropractic group h ad less severe symptoms than the booklet group at four weeks (P=0.02), and there was a trend toward less severe symptoms in the physical-the rapy group (P=0.06). However, these differences were small and not sig nificant after transformations of the data to adjust for their non-nor mal distribution. Differences in the extent of dysfunction among the g roups were small and approached significance only at one year, with gr eater dysfunction in the booklet group than in the other two groups (P =0.05). For all outcomes, there were no significant differences betwee n the physical-therapy and chiropractic groups and no significant diff erences among the groups in the numbers of days of reduced activity or missed work or in recurrences of back pain. About 75 percent of the s ubjects in the therapy groups rated their care as very good or excelle nt, as compared with about 30 percent of the subjects in the booklet g roup (P<0.001). Over a two year period, the mean costs of care were $4 37 for the physical-therapy group, $429 for the chiropractic group, an d $153 for the booklet group. Conclusions For patients with low back p ain, the McKenzie method of physical therapy and chiropractic manipula tion had similar effects and costs, and patients receiving these treat ments had only marginally better outcomes than those receiving the min imal intervention of an educational booklet. Whether the limited benef its of these treatments are worth the additional costs is open to ques tion. (N Engl J Med 1998;339:1021-9.) (C) 1998, Massachusetts Medical Society.