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Research That Matters: Medical Care Plus Chiropractic Is Superior

May 13, 2019

RESEARCH THAT MATTERS: MEDICAL CARE PLUS CHIROPRACTIC

-“ADJUSTED ODD RATIOS AT WEEK 6 WERE ALSO STATISTICALLY SIGNIFICANT IN FAVOR OF USUAL MEDICAL CARE PLUS CHIROPRACTIC OVERALL FOR PERCEIVED IMPROVEMENT AND SELF REPORTED PAIN MEDICATION USE.”

– “ADJUSTED MEAN DIFFERENCES AND SCORES AT WEEK 6 WERE STATISTICALLY SIGNIFICANT IN FAVOR OF USUAL MEDICAL CARE PLUS CHIROPRACTIC CARE COMPARED WITH USUAL MEDICAL CARE ALONE FOR LOW BACK PAIN INTENSITY.”

-“CHIROPRACTIC CARE WHEN ADDED TO USUAL MEDICAL CARE RESULTED IN MODERATE SHORT TERM TREATMENT BENEFITS IN BOTH LOW BACK PAIN INTENSITY AND DISABILITY, DEMONSTRATED A LOW RISK OF HARMS, AND LED TO A HIGH PATIENT SATISFACTION AND PERCEIVED IMPROVEMENT IN ACTIVE DUTY MILITARY PERSONNEL.  THIS TRIAL PROVIDES AN ADDITIONAL SUPPORT FOR THE INCLUSION OF CHIROPRACTIC AS A COMPONENT OF MULTIDISCIPLINARY HEALTHCARE FOR LOW BACK PAIN AS CURRENTLY RECOMMENDED IN EXISTING GUIDELINES.”

 

Objective

 To determine whether the addition of chiropractic care to usual medical care results in better pain relief and pain-related function when compared with usual medical care alone.

 

Design, Setting, and Participants  

A 3-site pragmatic comparative effectiveness clinical trial using adaptive allocation was conducted from September 28, 2012, to February 13, 2016, at 2 large military medical centers in major metropolitan areas and 1 smaller hospital at a military training site. Eligible participants were active-duty US service members aged 18 to 50 years with low back pain from a musculoskeletal source.

 

Interventions

The intervention period was 6 weeks. Usual medical care included self-care, medications, physical therapy, and pain clinic referral. Chiropractic care included spinal manipulative therapy in the low back and adjacent regions and additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies.

 

Results  

Of the 806 screened patients who were recruited through either clinician referrals or self-referrals, 750 were enrolled (250 at each site). The mean (SD) participant age was 30.9 (8.7) years, 175 participants (23.3%) were female, and 243 participants (32.4%) were nonwhite. Statistically significant site × time × group interactions were found in all models. Adjusted mean differences in scores at week 6 were statistically significant in favor of usual medical care plus chiropractic care compared with usual medical care alone overall for low back pain intensity (mean difference, −1.1; 95% CI, −1.4 to −0.7), disability (mean difference, −2.2; 95% CI, −3.1 to −1.2), and satisfaction (mean difference, 2.5; 95% CI, 2.1 to 2.8) as well as at each site. Adjusted odd ratios at week 6 were also statistically significant in favor of usual medical care plus chiropractic care overall for perceived improvement (odds ratio = 0.18; 95% CI, 0.13-0.25) and self-reported pain medication use (odds ratio = 0.73; 95% CI, 0.54-0.97). No serious related adverse events were reported.

 

Conclusions and Relevance  

Chiropractic care, when added to usual medical care, resulted in moderate short-term improvements in low back pain intensity and disability in active-duty military personnel. This trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines. However, study limitations illustrate that further research is needed to understand longer-term outcomes as well as how patient heterogeneity and intervention variations affect patient responses to chiropractic care.

 

Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial.  Goertz CM, Long CR, Vining RD, Pohlman KA, Walter J, Coulter I. JAMA Netw Open. 2018;1(1):e180105. doi:10.1001/jamanetworkopen.2018.0105

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