FROM:
British Medical Journal 1995 (Aug 5); 311 (7001): 349–351 ~ FULL TEXT
Meade TW, Dyer S, Browne W, Frank AO
Epidemiology and Medical Care Unit, Wolfson Institute of Preventive Medicine, Medical College, St Bartholomew's Hospital, London
OBJECTIVE: To compare the effectiveness over three years of chiropractic and hospital outpatient management for low back pain.
DESIGN: Randomised allocation of patients to chiropractic or hospital outpatient management.
SETTING: Chiropractic clinics and hospital outpatient departments within reasonable travelling distance of each other in 11 centres.
SUBJECTS: 741 men and women aged 18-64 years with low back pain in whom manipulation was not contraindicated.
OUTCOME MEASURES: Change in total Oswestry questionnaire score and in score for pain and patient satisfaction with allocated treatment.
RESULTS: According to total Oswestry scores improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear. Those treated by chiropractors had more further treatments for back pain after the completion of trial treatment. Among both those initially referred from chiropractors and from hospitals more rated chiropractic helpful at three years than hospital management.
CONCLUSIONS: At three years the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals.
From the Full-Text Article:
Discussion
The results at six weeks and six months shown in table I are identical with those in our first report, [1] as all patients had then been followed up for six months. The findings at one year are similar as many patients had also been followed up then. The considerably larger numbers of patients with data now available at two and three years show smaller benefits at these intervals than previously, [1] though these still significantly favour chiropractic. The substantial benefit of chiropractic on intensity of pain is evident early on and then persists. The consistently larger proportions lost to follow up throughout the trial in those treated in hospital than in those treated by chiropractic suggests greater satisfaction with chiropractic. This conclusion is supported (table III) by the higher proportions in each referral group considering chiropractic helpful by comparison with hospital treatment.
The main criticism of the trial after our first report centred on its "pragmatic" nature, particularly the larger number of chiropractic than hospital treatments and the longer period over which the chiropractic treatments were spread and which were deliberately allowed. These considerations and any consequences of the higher proportions of patients allocated to chiropractic who received further treatment in the later stages of follow up, however, do not apply to the results at six weeks and only apply to a limited extent at six months, when the proportions followed up were high and extra treatment had either not occurred at all or was not yet extensive. Benefits atributable to chiropractic were already evident (especially on pain, table II) at these shorter intervals.
We believe there is now more support for the need for "fastidious" trials focusing on specific components of management and on their feasibility. Meanwhile, the results of our trial show that chiropractic has a valuable part to play in the management of low back pain.
We thank Dr Iain Chalmers for commenting on an earlier draft of the paper. We thank the nurse coordinators, medical staff, physiotherapists, and chiropractors in the 11 centres for their work, and Dr Alan Breen of the British Chiropractic Association for his help. The centres were in Harrow, Taunton, Plymouth, Bournemouth and Poole, Oswestry, Chertsey, Liverpool, Chelmsford, Birmingham, Exeter, and Leeds. Without the assistance of many staff members in each the trial could not have been completed.
Funding: Medical Research Council, the National Back Pain Association, the European Chiropractors Union, and the King Edward's Hospital Fund for London.
