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A Randomized Trial of Treatments for Low Back Pain.
Despite numerous studies on treating low back pain (LBP), the relative merits of different therapies remain unclear. In this randomized trial from a Seattle-area HMO, 321 adults with at least one week of LBP received the McKenzie method of physical therapy (PT), chiropractic manipulation, or an educational booklet. The PT and chiropractic groups received a maximum of nine sessions over one month. Most patients had had LBP for less than six weeks, and about half had more than two previous episodes. Patients with sciatica and those involved in compensation or litigation claims were excluded.
Compared with the booklet group, the chiropractic group had a modest but statistically significant reduction in a symptom score (p=0.02) and the PT group had a trend toward a lower score (p=0.06) at one month. However, there were no significant differences at three months, one year, and two years. During the year after the episode, the groups were similar in missed work, reduced activity, and additional visits for LBP.
Comment: This study suggests that for some patients, chiropractic and PT may bring speedier resolution of uncomplicated LBP than an educational booklet. However, it's quite possible that the mere fact of seeing a health care provider repeatedly -- rather than the therapies themselves -- was responsible for much of the benefit. Whether the marginally better short-term outcomes with PT and chiropractic justify the extra cost of these treatments is an obvious question for policy makers.
— AS Brett
Published in Journal Watch General Medicine October 9, 1998
Citation(s):
Cherkin DC et al. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med 1998 Oct 8 339 1021-1029.
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