Who will get better? Predicting clinical outcomes in a chiropractic practice

Abstract

To determine if any characteristics exist in baseline data collected from chiropractic patients attending a private chiropractic practice that might predict success with chiropractic treatment. Prospective cohort study. Seven hundred and eighty-eight patients with low back pain (LBP) eligible for chiropractic treatment attending a private chiropractic clinic. Baseline Bournemouth Questionnaire (BQ) scores were collected together with patient gender and duration of symptoms. Outcomes were BQ scores and Patient Global Impression of Change (PGIC) scores at 4 and 12 weeks. Patients were categorised as ‘better’ if they chose the top two items of the scale. Odds ratios (OR) were calculated to detect potential predictors of outcome. Baseline BQ scores were higher in acute patients with females tending to score higher particularly in depression. Around 74% of patients get better at 4 weeks with a statistically and clinically significant drop of 27 points on the BQ. Further improvement was minimal up to 12 weeks. Having low back pain for less than 4 weeks reduced the risk of poor recovery at 4 and 12 weeks [OR 0.56 (95% CI 0.36–0.88) and 0.41 (95% CI 0.26–0.67)]. In this group low depression scores were also associated with better outcomes in male patients [OR 0.1 (95% CI 0.01–0.55)] while low social disability scores were associated with better outcomes in females [OR 0.1 (95% CI 0.01–0.94)]. Different subgroups of LBP patients that are likely to succeed with chiropractic intervention can be identified using routinely collected data in a chiropractic practice. Duration of symptoms, found here as a predictor, is in agreement with other larger studies although some predictors are unique to this practice population. Further research is needed exploring the possible differences between patients with different duration of other conditions and the potential influence of gender.