Dose-response for chiropractic care of chronic low-back pain

Wyatt, Lawrence H

Dose-response for chiropractic care of chronic low-back pain.

Haas M, Groypp E, Kraemer DF. Spine 2004 Sep-Oct;4(5):83.


Background: There have been no trials of optimal chiropractic care in terms of number of office visits for spinal manipulation and other therapeutic modalities.

Purpose: To conduct a pilot study to make preliminary identification of the effects of the number of chiropractic treatment visits for manipulation with and without physical modalities (PM) on chronic low-back pain and disability.

Study Design/Setting: Randomized controlled trial with a balanced 4×2 factorial design. Conducted in the faculty practice of a chiropractic college outpatient clinic.

Patient Sample: Seventy-two patients with chronic, nonspecific low-back pain of mechanical origin.

Main Outcome Measures: Von Korff pain and disability (100-point) scales.

Methods: Patients were randomly allocated to visits (1, 2, 3, or 4 visits/week for 3 weeks) and to treatment regimen (spinal manipulation only or spinal manipulation with PM). All patients received high-velocity, low-amplitude spinal manipulation. Half received one or two of the following PM at each visit: soft-tissue therapy, hot packs, electrotherapy, or ultrasound.


Pain intensity: At 4 weeks, there was a substantial linear effect of visits favoring a larger number of visits: 5.7 points per 3 visits (SE=2.3, p=.014). There was no effect of treatment regimen. At 12 weeks, the data suggested the potential for a similar effect of visits on patients receiving both manipulation and PM. Functional disability: At 4 weeks, a visits effect was noted (p=.018); the slope for group means was approximately 5 points per 3 visits.There were no group differences at 12 weeks.

Conclusions: There was a positive, clinically important effect of the number of chiropractic treatments for chronic low-back pain on pain intensity and disability at 4 weeks. Relief was substantial for patients receiving care 3 to 4 times per week for 3 weeks.

Comments: This is the first study of the dose-response relationship for spinal manipulation and physical medicine interventions. It illustrates an apparent relationship between increased dosage and patient response to spinal manipulation, but it also illustrates that physical medicine interventions had little effect on outcome at 4 weeks, which is consistent with previous evidence. At 12 weeks, however, there was no difference between groups. Given that this was a pilot study, larger studies will provide better and more useful information.

Copyright American Chiropractic Association Dec 2004

Provided by ProQuest Information and Learning Company. All rights Reserved

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