Aug 7 2012
By Lucy Piper, Senior MedWire Reporter
Patients with low back pain (LBP) undergoing chiropractic treatment who respond to treatment are likely to improve very quickly, study findings show.
This appears to be true for those with acute (<4 weeks) and chronic (>3 months) pain.
The researchers found that treatment response on the Patient Global Impression of Change (PGIC) scale 1 week after treatment was a good indicator of outcome.
Indeed, patients with chronic and acute LBP who were "much better" or "better" on the PGIC scale at 1 week were four to five times more likely to be improved at both 1 and 3 months after treatment than patients who had not improved at 1 week.
The team also points out that "an important and unique finding in this current study is that although 123 (23%) of the patients with acute LBP and 71 (24%) of the patients with chronic LBP were diagnosed by their chiropractors as having radiculopathy, this finding was not a negative predictor of improvement."
Cynthia Peterson (University of Zurich, Switzerland) and colleagues investigated the outcomes of 523 patients with acute LBP and 293 with chronic LBP receiving chiropractic treatment.
After 1 week of treatment, 65% of patients with acute pain and 32% of patient with chronic pain reported that they were either "much better" or "better." The respective rates were 81% and 59% at 1 month and 88% and 69% at 3 months.
The most consistent factor predicting outcome was self-reported improvement at 1 week, which was independently associated with improvement at 1 month (odds ratio [OR]=2.4 for acute LBP and 5.0 for chronic LBP) and 3 months (OR=2.9 and 3.3, respectively).
Among the patients with chronic pain, other prognostic factors included trauma onset as the reason for LBP, a history of LBP episodes, and the Oswestry baseline score ‑ for every 1-point increase in the baseline Oswestry score, patients with chronic pain were 6% less likely to improve at 1 month.
These findings could help practicing chiropractors "make more confident decisions about patient prognosis based on how quickly individual patients respond to their treatment," the researchers report in the Journal of Manipulative and Physiological Therapeutics.
"Chiropractors can also expect most of their patients with acute and chronic pain to continue to improve at least up to 3 months after the start of treatment, even if they are no longer being treated."
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