Chiropractic Adds “Significant Advantage” to Medical Care

By Editorial Staff

Dynamic Chiropractic – November 1, 2013, Vol. 31, Issue 21

Originally announced briefly in an earlier issue of Dynamic Chiropractic, a study published in Spine examined the potential benefits of adding “chiropractic manipulative therapy” (CMT) to “standard medical care” (SMC) for 18-35-year-old active-duty military personnel with low back pain (LBP).¹ The pragmatic, patient-centered, two-arm, randomized, controlled trial pilot study was funded by a grant from the Samueli Institute and conducted from February 2008 – June 2009 at William Beaumont Army Medical Center (WBAMC) at Fort Bliss, El Paso, Texas.

This study compared standard medical care to standard medical care plus chiropractic manipulative therapy, with SMC including “any or all of the following: a focused history and physical examination, diagnostic imaging as indicated, education about self-management including maintaining activity levels as tolerated, pharmacological management with the use of analgesics and anti-inflammatory agents, and physical therapy and modalities such as heat/ice and referral to a pain clinic.”

Patients who received CMT as well as SMC “were scheduled for up to 2 visits weekly with a doctor of chiropractic (DC) for a period of 4 weeks. The initial visit with the DC included a focused history and physical examination and diagnostic imaging as indicated. Treatments consisted of HVLA manipulation as the primary approach in all cases, with ancillary treatments at the doctor’s discretion.” Progress was measured at both two weeks and four weeks, with results summarized by the study authors as follows:

• “Mean RMQ (Roland-Morris Disability Questionnaire) scores decreased in both groups during the course of the study, but adjusted mean scores were significantly better in the SMC plus CMT group than in the SMC group at both week 2 ( SMC adjusted mean 12.9 vs. 8.9 for SMC+CMT) and week 4 (SMC adjusted mean 12.0 vs. 8.0 for SMC+CMT).”
• “Mean NRS (numerical rating scale) pain scores were also significantly better in the group that received CMT. (SMC 6.1 vs. 3.9 for SMC+CMT at week 2 and SMC 5.2 vs. 3.9 for SMC+CMT at week 4).”
• “Adjusted mean Back Pain Functional Scale scores were significantly higher (improved) in the SMC plus CMT group than in the SMC group at both week 2 (SMC 32.9 vs. SMC+CMT 42.9) and week 4 (SMC 35.3 vs. SMC+CMT 43.0).”
• “Seventy-three percent of participants in the SMC plus CMT group rated their global improvement as pain completely gone, much better, or moderately better, compared with 17% in the SMC group.”
• “The mean satisfaction with care score on a 0 to 10 scale for the SMC plus CMT group was 8.9 at both weeks 2 and 4; the mean for the SMC group was 4.5 at week 2 and 5.4 at week 4.”

The study also noted: “[P]articipants in the SMC group were twice as likely to have received medication as those in the SMC plus CMT group. It is difficult to attribute improvement to any 1 component of the care provided. Both treatment groups combined medication with physical modalities and medication was prescribed in less than half of the patients. However, our results suggest that the somewhat increased medication use in the SMC group did not confer a significant benefit.”

In addition to the improved outcomes chiropractic can provide military personnel, these results present an opportunity for non-military DCs and primary-care MDs to work together. Most back pain suffers will see one of more than 200,000 primary-care medical physicians before they see a doctor of chiropractic. DCs should consider purchasing a copy of this study and sharing it with MDs in their community. It is a little pricey, but may be the best $59 you’ve ever spent. Visit http://journals.lww.com/spinejournal/ and type “Christine Goertz” (the lead study author) in the upper-left search box to access and purchase the article

References

1. “Study Published in Spine Demonstrates Significant Improvement in Low Back Pain for Active-Duty Military Patients Receiving Chiropractic Care.” Palmer College of Chiropractic press release, April 15, 2013.
2. Goertz CM, Long CR, Hondras MA, Petri R, Delgado R, Lawrence DJ, Owens EF, Meeker WC. Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: results of a pragmatic randomized comparative effectiveness study. Spine, 2013 Apr 15;38(8):627-34.