Abstract
BackgroundIt is clinically important to be able to select patients suitable for treatment and to be able to predict with some certainty the outcome for patients treated for low back pain (LBP). It is not known to what degree outcome among chiropractic patients is affected by psychological factors.ObjectivesTo investigate if some demographic, psychological, and clinical variables can predict outcome with chiropractic care in patients with LBP.MethodsA prospective multi-center practice-based study was carried out, in which demographic, clinical and psychological information was collected at base-line. Outcome was established at the 4th visit and after three months. The predictive value was studied for all base-line variables, individually and in a multivariable analysis.ResultsIn all, 55 of 99 invited chiropractors collected information on 731 patients. At the 4th visit data were available on 626 patients and on 464 patients after 3 months. Fee subsidization (OR 3.2; 95% CI 1.9-5.5), total duration of pain in the past year (OR 1.5; 95% CI 1.0-2.2), and general health (OR 1.2; 95% CI 1.1-1.4) remained in the final model as predictors of treatment outcome at the 4th visit. The sensitivity was low (12%), whereas the specificity was high (97%). At the three months follow-up, duration of pain in the past year (OR 2.1; 95% CI 1.4-3.1), and pain in other parts of the spine in the past year (OR1.6; 1.1-2.5) were independently associated with outcome. However, both the sensitivity and specificity were relatively low (60% and 50%). The addition of the psychological variables did not improve the models and none of the psychological variables remained significant in the final analyses. There was a positive gradient in relation to the number of positive predictor variables and outcome, both at the 4th visit and after 3 months.ConclusionPsychological factors were not found to be relevant in the prediction of treatment outcome in Swedish chiropractic patients with LBP.
Highlights
It is clinically important to be able to select patients suitable for treatment and to be able to predict with some certainty the outcome for patients treated for low back pain (LBP)
Participating patients Consecutive patients who sought care for LBP with or without pain radiating into the leg, who were new to the clinic or had not received chiropractic treatment within the past three months, were invited to participate in the study in the spring of 2006, providing that they returned for treatment at least once
Almost 50% reported the duration of pain for the present problem to have lasted at least 2 weeks and the total duration in the past year was at least 30 days for 50%
Summary
It is clinically important to be able to select patients suitable for treatment and to be able to predict with some certainty the outcome for patients treated for low back pain (LBP). It is our experience that many chiropractors have a biomechanical rationale for their treatment of low back pain (LBP). The purpose of spinal manipulation would primarily be to normalize the mechanics of the spine. During the initial stage, manipulation is used to reduce the pain and increase the patients' ability to move about in a more relaxed manner, whereupon they are encouraged to combine rest with movement. Patients are encouraged to increase their activities in an individually tailored fashion, to avoid the problems to recur. Sometimes specific movements or exercises are prescribed to counteract unsuitable postures or weaknesses of the spine
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