Scientific Articles
Chiropractic for Chronic LBP: Maintenance Care Better Than Short-Term Therapy
Insurance companies, medical doctors and other health care providers who
question the value of chiropractic maintenance care, particularly for
low back pain, should consider findings from
a new study published in the prestigious medical journal, Spine,
which asks (and then answers) the question, "Does Maintained Spinal
Manipulation Therapy for Chronic Non-Specific Low Back Pain Result in
Better Long-Term Outcome?"
The study suggests patients with low back pain of at least six months
duration experience greater improvement following one month (12
treatments) of spinal manipulative therapy,(chiropractic care) followed
by "maintenance spinal manipulation" every two weeks for nine months
than subjects who receive one month of SMT only (12 treatments)…
Patients in the manipulation and manipulation-plus-maintenance groups
improved with respect to pain and disability after one month compared to
the untreated group, but after 10 months, only the group receiving
maintenance care reported significant, long-term improvement. The
one-month-only group's who did not receive “maintenance” care showed a
return of their pain and disability scores to "near pretreatment
level."…
Measurements of spine flexion and lateral bending also revealed
sustained improvements in subjects receiving maintenance SMT, while
improvements in the no-maintenance group during the initial phase of
care decreased to near the pretreatment level by the end of the second
phase.
Source: Senna MK, Machaly SA. Spine (published ahead of print), Jan. 17, 2011. doi: 10.1097/BRS.0b013e3181f5dfe0
Lower disability recurrence when workers' comp patients receive DC maintenance care vs. care by PTs or MDs.
A study published in the April 2011 issue of the Journal of Occupational
and Environmental Medicine suggests that when it comes to work-related
low back pain, the risk of disability recurrence is lower for
patients treated primarily ("only or mostly") by a doctor of
chiropractic than patients treated only/mostly by a physical therapist
or a physician. The study defined recurrence in terms of disability
following return to work, while patients were under "health maintenance
care" by their provider. From a cost perspective, the study also found
that average costs of care per disability episode and during the "health
maintenance phase" following return to work were higher for patients
with recurrent episodes of LBP compared to those with no such
recurrence.
A large insurance company representing an estimated 10 percent of U.S.
workers' compensation cases provided data for the study. Low back
pain cases (11,420 new cases of nonspecific LBP) were identified via the
company's administrative records and all claimants were tracked from the
initial date of injury until one year following the first episode of
disability. Claimants who had filed a workers' compensation claim for
nonspecific LBP in the prior year were identified and excluded, allowing
for evaluation of new-onset cases of nonspecific LBP only (894 cases;
average age: 41 years).
Likelihood of Recurrence
"Provider type during the health maintenance care period was
significantly associated with recurrent disability ... with the only
or mostly physical therapy group having the highest proportion of
recurrent disability (16.9%) and the only or mostly chiropractor and the
no health maintenance care groups having the lowest proportion of
recurrent disability (6.5% and 5.5%, respectively)." More than 12
percent (12.5%) of patients receiving care from a physician experienced
recurrent disability.
Authors' Conclusion
"After controlling for demographic factors and multiple severity
indicators, patients suffering nonspecific work-related LBP who received
health services mostly or only from a chiropractor had a lower risk of
recurrent disability than the risk of any other provider type. Even
without an improvement in days until recurrent disability, our findings
seem to support the use of chiropractic services, as chiropractor
services generally cost less than services from other providers. If a
lower rate of disability recurrence in work-related LBP cases for
chiropractors [holds true], it is important to identify the mechanism of
action."
Chiropractic Maintenance Care
The Cifuentes, et al., findings come on the heels of the
Senna, et al., study in Spine that found chronic LBP patients who
received nine months of maintenance spinal manipulative therapy
following one month of treatment reported significant improvement in
pain and disability. Patients who received only the initial month of
treatment reported diminishing improvement over time, with pain and
disability scores returning essentially to pretreatment levels after 10
months.
Access the complete workers' comp study in the print issue of JOEM or online: Cifuentes M, Willetts J, Wasiak R. Health maintenance care in work-related low back pain and its association with disability recurrence. JOEM, April 2011;53(4):396-404.