Study Compares Effectiveness of Chiropractors and Out-Patient Hospital Care for Low Back Pain
By Richard H. Adler
November 13, 1991
In 1990, the British Medical Journal reported on the long-awaited results of the British Medical Research Council’s ten year study comparing chiropractic and out-patient hospital care of patients suffering from acute and chronic mechanical low back pain.
The Cochrane Commission’s 1979 report on back pain made several recommendations, one of which was that clinical trials should be established to test the value of “alternative” methods of management. Chiropractors persuaded the Medical Research Council to first establish a pilot trial and then a clinical trial, which is the subject of the current study.
This latest trial was devised and completed by the Medical Research Council Epidemiology & Medical Care Unit at the Clinical Research Center in Harrow, England. Twelve hospital centers and nearby chiropractic clinics were recruited for the study.
This study follows 741 patients between the ages of 18 and 65. This is far more than in any previous trial; as such, the reliability of this study is significant. Individuals were excluded from the study if they had major structural abnormalities visible on x-ray, evidence of nerve root involvement, treatment within the preceding month, or had treated at a hospital or chiropractic clinic involved in the trial within the past two years.
The study used two “outcome measures” of evaluation. One measure is based on a back pain disability questionnaire (Oswestry Back Disability Index), which rates and scores back pain and changes in pain as reported by the patient. The Oswestry Back Disability Index, once regarded as “soft” evidence, is now accepted as “hard” evidence. The second outcome measure was an “objective” measurement of degrees of straight leg raising and lumbar flexion. The subjective and objective measurements were then completed.
The researchers found a significant, reliable, and measurable advantage for chiropractic treatment over conventional hospital out-patient management of back pain. The results reflected that patients receiving chiropractic treatment, rather than conventional hospital out-patient management, were able to do more with less pain, particularly as related to sitting for more than 30 minutes to an hour and lifting weights. Chiropractic patients did better on degrees of improvement of right straight leg raising (physical therapy 5.0 degrees; chiropractic 7.1 degrees), left straight leg raising (physical therapy 5.3 degrees; chiropractic 5.8 degrees), and lumbar flexion (physical therapy .62 centimeters; chiropractic .85 centimeters). This difference occurred not only at six weeks, but also at one, two, and even (113 patients followed so far) three years post-treatment. The difference was seen most strongly in patients with chronic symptoms.
The authors concluded that whatever the explanation for the difference between the two approaches, this pragmatic comparison of two types of treatment used in day-to-day practice shows that “patients treated by chiropractors…almost certainly fared considerably better and maintained their improvement advantage for at least two years.”
If you would like a copy of this study, please call our office and we will forward it to you.
Very truly yours,
ADLER GIERSCH, P.S.
Richard H. Adler
Attorney at Law
1 Mead T.W. Dyer S., et al. “Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Out-Patient Treatment,” British Medical Journal, vol. 300: 1431-1437 (1990).
2 Chiropractic manipulation is not necessarily inappropriate for patients excluded on these grounds. Indeed, there is evidence of effectiveness in the presence of nerve root compression and disc herniation. Cassidy, J.D.; Kirkaldy-Willis, W. H.; McGregor, M., “Spinal Manipulation for the Treatment of Chronic Low Back Pain and Leg Pain: An Observational study,” Ch. 9, Empirical Approaches to the Validation of Spinal Manipulation, (1985); Quon, J.A., Cassidy, J.D., et al. “Lumbar Intervertebral Disc Herniation: Treatment by Rotational Manipulation,” J.M.P.T., 12(3): 220-227; Cox, J.M., “Lumbosacral Disc Protrusion: A Case Report,” J.M.P.T., 8(4): 261-266; Nwuga, V.B.C., “Relative Therapeutic Efficacy of Vertebral Manipulation and Conventional Treatment in Back Pain Management,” American Journal Physical Medicine, 61: 273-278. Also, it should be noted that the percentage of chiropractic care patients over age 65 is almost double that in the general population. Coulter, I.D., “The Chiropractic Patient: A Social Profile,” J.C.C.A., 29(1): 25-28.
3 Deyo, R.A., and Diehl, A.K., “Measuring Physical and Psycho-Social Function in Patients with Low Back Pain,” Spine, 8(6): 635-642 (1983); McDowell, I., and Newell, C., “Measuring Health: A Guide to Rating Scales and Questionnaires,” Oxford University Press, New York and Oxford (1987); Fairbank, J., Coupar, J., et al., “The Oswestry Low Back Pain Disability Questionnaire,” Physiotherapy, 66: 271-273 (1980); Deyo, R.A., “Personal Communication,” Seattle Consensus Conference, March 2, 1990.