Dose-response for chiropractic care of chronic low back pain

Abstract

Background context There have been no trials of optimal chiropractic care in terms of number of office visits for spinal manipulation and other therapeutic modalities. Purpose To conduct a pilot study to make preliminary identification of the effects of number of chiropractic treatment visits for manipulation with and without physical modalities (PM) on chronic low back pain and disability. Study design/setting Randomized controlled trial with a balanced 4×2 factorial design. Conducted in the faculty practice of a chiropractic college outpatient clinic. Patient sample Seventy-two patients with chronic, nonspecific low back pain of mechanical origin. Main outcome measures Von Korff pain and disability (100-point) scales. Methods Patients were randomly allocated to visits (1, 2, 3 or 4 visits/week for 3 weeks) and to treatment regimen (spinal manipulation only or spinal manipulation with PM). All patients received high-velocity low-amplitude spinal manipulation. Half received one or two of the following PM at each visit: soft tissue therapy, hot packs, electrotherapy or ultrasound. Results Pain intensity: At 4 weeks, there was a substantial linear effect of visits favoring a larger number of visits: 5.7 points per 3 visits (SE=2.3, p=.014). There was no effect of treatment regimen. At 12 weeks, the data suggested the potential for a similar effect of visits on patients receiving both manipulation and PM. Functional disability: At 4 weeks, a visits effect was noted (p=.018); the slope for group means was approximately 5 points per 3 visits. There were no group differences at 12 weeks. Conclusions There was a positive, clinically important effect of the number of chiropractic treatments for chronic low back pain on pain intensity and disability at 4 weeks. Relief was substantial for patients receiving care 3 to 4 times per week for 3 weeks.