Manual
Therapy Research
|
| Paper
Title |
Chiropractic
Management of Mechanical Neck and Low-Back Pain: A Retrospective,
Outcome-Based Analysis |
| Author(s) |
Gordon
McMorland and Esther Suter |
| Journal
Reference |
Journal
of Manipulative & Physiological Therapeutics 2000; 23( 5): 307-312 |
| Background |
Evidence
suggests that spinal manipulation is an effective treatment for mechanical
neck and low-back pain (LBP). Treatment efficacy is important to establish
for these symptoms because combined they account for a considerable amount
of disability and substantial associated direct and indirect costs to
society. |
| Objective |
The
purpose of this study was to examine the outcome of patients undergoing
chiropractic treatment for mechanical neck or LBP |
| Design
and Setting |
A
retrospective, outcome-based analysis was done for patients seeking care
at a private chiropractic practice over a 1 -year period. A total of 512
files were reviewed, with 119 patients selected for inclusion. Patients
were included if their chief symptom was uncomplicated mechanical neck or
LBP. Diagnoses included cervical, lumbar, or sacroiliac joint sprain/
strain (International Code of Diagnostics version 9 [ICD-9] code: 847.1,
847.3, 846.1, respectively), discogenic LBP (ICD-9: 722.1), and headaches
(ICD-9: 784.0) because many patients with neck pain presented with
concomitant headaches. Disability and pain were measured with the modified
Oswestry scale (for the patients with LBP), Neck Disability Index, and an
11-box visual analogue pain scale before and after treatment. Treatment
consisted of spinal manipulation, various soft-tissue techniques,
home-care instructions, and ergonomic and return-to-activity advice,
including rehabilitative exercises. Patients received an average of 12
treatments over a 4-week period. |
| Statistical
Analysis |
Statistical
analysis was performed on pretreatment and post-treatment values for both
disability and pain. Stratification was based on duration (acute/subacute,
chronic, acute exacerbation of a chronic condition) and severity (mild,
moderate, or severe) of symptoms.
|
| Results |
Statistically
significant reductions in disability and pain scores were achieved in all
groups. An average 52.5% and 52.9% reduction in pain and disability,
respectively, was achieved in the low back group. The chronic LBP group
realized a less statistically significant reduction of pain and disability
(19.7% and 19.8%, respectively) than the acute/subacute (66.8% and 62.5%)
or the chronic/recurrent group (56.5% and 63.4%). The differences were
statistically significant. Patients with neck pain had an average 53.8%
and 48.4% reduction in their pain and disability, respectively. Patients
with concomitant neck pain and headaches had statistically significant
higher pretreatment and posttreatment disability and pain scores than
those with only neck pain. There was no statistically significant
difference in outcomes between groups stratified according to pain
intensity. |
| Authors' Conclusions |
Patients
attending a private chiropractic clinic for treatment of mechanical neck
pain or LBP had statistically significant reductions in their pain-related
disability after treatment. These results indicate that chiropractic
manipulation is beneficial for the treatment of mechanical neck pain and
LBP. However, care must be taken when drawing conclusions from these
outcomes. The study design does not account for the natural history of low
back- or neck pain-related disability and therefore does not allow for
claims of treatment efficacy. In addition, it has been suggested that
patients presenting to medical doctors with these symptoms have
significant overlying comorbidity when compared with patients presenting
to a chiropractor. |
| Clinical
Significance |
Due
to the study design, few absolute conclusions may be drawn from this study
relative to manipulative treatment of the neck and low back for mechanical
pain. Although patients achieved significant reductions in pain and
disability, they must be compared to a non-treatment group to determine if
the cause of the recovery was related to the treatment itself, or the
"natural history" of the condition whereby the patient would
have recovered in the same time frame regardless of treatment.
Although it shines a positive light on the potential benefits from
manipulation for mechanically related pain of the neck and low back, this
research alone must be considered carefully and in conjunction with other
research to develop a more complete clinical picture. |
| NOTE:
The clinical significance review is the opinion of Dr Ken Mueller based
upon the information available at the time of posting. Unauthorized
use of the section on clinical significance is prohibited by Canadian
Copyright. The above research abstract is based on information
posted on the JMPT
website.
For further information, please refer to the original article utilizing
the publication information provided. January 3, 2005 |
