The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: Findings from the UCLA low back pain study

Eric L. Hurwitz, Hal Morgenstern, Philip Harber, Gerald F. Kominski, Thomas R. Belin, Fei Yu, Alan H. Adams

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

Background: Although chiropractors often use physical modalities with spinal manipulation, evidence that modalities yield additional benefits over spinal manipulation alone is lacking. Objective: The purpose of the study was to estimate the net effect of physical modalities on low back pain (LBP) outcomes among chiropractic patients in a managed-care setting. Methods: Fifty percent of the 681 patients participating in a clinical trial of LBP treatment strategies were randomized to chiropractic care with physical modalities (n = 172) or without physical modalities (n = 169). Subjects were followed for 6 months with assessments at 2, 4, and 6 weeks and at 6 months. The primary outcome variables were average and most severe LBP intensity in the past week, assessed with numerical rating scales (0-10), and low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire. Results: Almost 60% of the subjects had baseline LBP episodes of more than 3 months’ duration. The 6-month follow-up was 96%. The adjusted mean differences between groups in improvements in average and most severe pain and disability were clinically insignificant at all follow-up assessments. Clinically relevant improvements in average pain and disability were more likely in the modalities group at 2 and 6 weeks, but this apparent advantage disappeared at 6 months. Perceived treatment effectiveness was greater in the modalities group. Conclusions: Physical modalities used by chiropractors in this managed-care organization did not appear to be effective in the treatment of patients with LBP, although a small short-term benefit for some patients cannot be ruled out.

Original languageEnglish (US)
Pages (from-to)10-20
Number of pages11
JournalJournal of Manipulative and Physiological Therapeutics
Volume25
Issue number1
DOIs
StatePublished - Dec 11 2002

Keywords

  • Chiropractic
  • Hysical Therapy
  • Low Back Pain
  • Managed Care
  • Randomized Controlled Trial

ASJC Scopus subject areas

  • Chiropractics

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