Abstract
BackgroundLow back pain in pregnancy is common and research evidence on the response to chiropractic treatment is limited. The purposes of this study are 1) to report outcomes in pregnant patients receiving chiropractic treatment; 2) to compare outcomes from subgroups; 3) to assess predictors of outcome.MethodsPregnant patients with low back or pelvic pain, no contraindications to manipulative therapy and no manual therapy in the prior 3 months were recruited.Baseline numerical rating scale (NRS) and Oswestry questionnaire data were collected. Duration of complaint, number of previous LBP episodes, LBP during a previous pregnancy, and category of pain location were recorded.The patient’s global impression of change (PGIC) (primary outcome), NRS, and Oswestry data (secondary outcomes) were collected at 1 week, 1 and 3 months after the first treatment. At 6 months and 1 year the PGIC and NRS scores were collected. PGIC responses of ‘better’ or ‘much better’ were categorized as ‘improved’.The proportion of patients ‘improved’ at each time point was calculated. Chi-squared test compared subgroups with ‘improvement’. Baseline and follow-up NRS and Oswestry scores were compared using the paired t-test. The unpaired t-test compared NRS and Oswestry scores in patients with and without a history of LBP and with and without LBP during a previous pregnancy. Anova compared baseline and follow-up NRS and Oswestry scores by pain location category and category of number of previous LBP episodes. Logistic regression analysis also was also performed.Results52% of 115 recruited patients ‘improved’ at 1 week, 70% at 1 month, 85% at 3 months, 90% at 6 months and 88% at 1 year. There were significant reductions in NRS and Oswestry scores (p < 0.0005). Category of previous LBP episodes number at one year (p = 0.02) was related to ,improvement’ when analyzed alone, but was not strongly predictive in logistic regression. Patients with more prior LBP episodes had higher 1 year NRS scores (p = 0.013).ConclusionsMost pregnant patients undergoing chiropractic treatment reported clinically relevant improvement at all time points. No single variable was strongly predictive of, improvement’ in the logistic regression model.
Highlights
Low back pain in pregnancy is common and research evidence on the response to chiropractic treatment is limited
In order to obtain 1 year outcomes data on these 115 patients, 143 were enrolled with baseline data. Seven of these 143 patients requested to drop out of the study prior to the 1 year data collection time point and 28 other patients were not able to be contacted for 3 consecutive telephone data collection time periods
At 3 months, 6 months and 1 year the model was not statistically significant as the vast majority of patients were ‘improved’. The results of this current study which showed that a high proportion of pregnant patients with Low back pain (LBP) undergoing chiropractic treatment reported clinically relevant ‘improvement’ support those published in a recent cohort study as well as the recent randomized clinical trial (RCT) looking at chiropractic treatment for pregnant patients with low back or pelvic pain [16,17]
Summary
Low back pain in pregnancy is common and research evidence on the response to chiropractic treatment is limited. The high prevalence of this problem (50-80% of women) and the impact that this may have on their quality of life, as well as the fact that back pain during pregnancy is commonly linked to low back pain persisting after pregnancy, mandates that it be taken seriously by health care practitioners [1,2,3,4,5,6] Many of these patients rate their back pain as moderate to severe with a small percentage claiming to be significantly disabled by the pain [6,7,8]. Other authors have used 4 categories for pelvic only pain, including anterior pain at the pubic symphysis (symphysiolysis) but excluding lumbar spine pain [11]
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