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

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

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

Abstract

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

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

Study Design/Setting: Randomized controll trial with a balanced 4x2 factorial design. guidanceed in the faculty practice of a chiropractic corporation outpatient clinic.

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

Main result 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 alone or spinal manipulation with PM) All patients received high-velocity, low-amplitude spinal manipulation. Half received single or two of the following PM at each visit: soft-tissue therapy, burning packs, electrotherapy, or ultrasound.

Results:

Pain intensity: At 4 weeks, there was a substantial linear issue of visits favoring a larger number of visits: 57 points for 3 visits (SE=2.3, p=.014). There was no consequence of treatment regimen. At 12 weeks, the data intimateed the potential for a similar event of visits on patients receiving the pair manipulation and PM. Functional disability: At 4 weeks, a visits event was noted (p=.018); the direction downward for group means was approximately 5 points through 3 visits.There were no cluster differences at 12 weeks.

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

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

Copyright American Chiropractic Association Dec 2004

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