J Manipulative Physiol Ther 2006 (May); 29 (4): 288–296
Michael T. Haneline, DC, MPH
Palmer College of Chiropractic West, San Jose, California 95134, USA. firstname.lastname@example.org
Acute Neck Pain: Significant Relief, Satisfaction With Chiropractic Treatment
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Neck pain, whether chronic or acute, is nearly as prevalent in the American adult population as back pain; estimates show that up to two-thirds of all American adults will suffer from neck pain at some point in their lives. While millions of chiropractic manipulations are performed in the United States each year for the treatment of neck pain, relatively little investigative research has been conducted regarding the treatment of neck pain with chiropractic manipulation, and even less research has been conducted on the use of chiropractic care to treat acute neck pain.
The purpose of this two-part retrospective survey was to determine the extent to which patients with acute neck pain benefited from chiropractic manipulative therapy, and the degree to which they were satisfied with the care they received. Part one evaluated various aspects of chiropractors' treatment of 94 patients (60 women, 34 men; average age 39.6 years) suffering from acute neck pain. In part two, patients responded to a telephone survey to measure pre- and post-treatment pain levels, along with their level of satisfaction with the treatment they received.
OBJECTIVE: The aim of this study was to determine the extent to which a group of patients with acute neck pain managed with chiropractic manipulative therapy benefited from chiropractic care and the degree to which they were subsequently satisfied.
METHODS: A two-part retrospective survey, each composed of 14 questions. One part was completed by practicing doctors of chiropractic concerning various aspects of their treatment for patients with former acute neck pain. In the second part, these same patients responded to a telephone survey to measure pre- and posttreatment pain levels and their level of satisfaction with the treatment they received. Chiropractic manipulative therapy was the primary independent variable, although other therapies were used, such as physical therapy, nutritional advice, and exercise.
RESULTS: A total of 115 patients were contacted, of whom 94 became study participants, resulting in 60 women (64%) and 34 men. The mean age was 39.6 years (SD, 15.7). The mean number of visits was 24.5 (SD, 21.2). Pain levels improved significantly from a mean of 7.6 (median, 8.0) before treatment to 1.9 (median, 2.0) after treatment (P < .0001). The overall patient satisfaction rate was 94%.
CONCLUSION: Patients with acute neck pain involved in this study seemed to be satisfied with chiropractic treatment and reported reductions in associated pain levels and activity restrictions. However, because of the study's design and limitations, care must be taken before drawing firm conclusions from the data presented.
From the Full-Text Article:
This study, representing data from 94 patients who attended a total of 2303 chiropractic office visits, showed that the treatment for patients with acute neck pain by chiropractic methods may be beneficial. Participating patients, for the most part, indicated that they noticed less pain and disability after treatment. They also indicated that they were satisfied with the care that they received, and most of them would choose similar care for an episode of the same condition in the future.
The overall patient satisfaction level was determined to be 94% when including all patients who reported that they were either satisfied or very satisfied with their care. This level was better than anticipated because it was higher than previous reports. Although there are no studies available for direct comparison that have reported satisfaction levels regarding the treatment of acute neck pain by CMT, Wolsko et al (27) reported that chiropractic was rated as “very helpful” by 61% of those respondents who received treatment of back or neck pain. In addition, Jordan et al (17) reported “good” satisfaction with chiropractic manipulative treatment in a group of patients with chronic neck pain.
Treatment adherence may be another indicator of how satisfied patients were with the care they received, although this supposition has not been investigated. The rationale for this statement is that if patients are satisfied with the treatment they receive, they will be more likely to follow through and complete their treatment plan. If not, they may decide to try another method of treatment and discontinue care. Generally speaking, treatment adherence was fair in this study, given that nearly two thirds of the patients completed their treatment plan.
In the study's group of acute patients, mean neck pain levels before treatment were nearly 4 times greater than they were at the completion of treatment. Furthermore, after at least 1 year since the patients' initial visit, the study yielded mean pain reductions of 5.6 points. In comparison, a study by Hurwitz et a (l8) reported mean reductions of average neck pain on a mixed group composed of acute, subacute, or chronic chiropractic patients, also using an 11-point scale. At follow-up 6 months after the initial visit, there was a two-point reduction of pain. Another mixed group study by Cassidy et al (28) reported improvement of neck pain before and after CMT using the 101-point numerical rating (NRS-101) scale. They indicated that before treatment mean, NRS-101 scores were 43.7, compared with 31.1 after treatment. Because the NRS-101 scale is a progressive numerical scaling method from 1 to 100, this measurement would approximate a 1.3-point reduction on the 11-point scale. However, treatment only involved one CMT to the neck, and pain levels were ascertained immediately after treatment.
Reduction of Disability
There were reductions in disability recorded during the study that were statistically significant. Approximately 84% of the patients related that their activities were restricted before chiropractic treatment because of their neck pain, whereas only 25% still had activity restrictions at the time of the interview. Furthermore, 57% of those with physical restrictions described their disabilities as moderately severe or greater before treatment, whereas at the time of the interview, just 12% did. No studies have addressed the issue of disability reduction regarding a group exclusively composed of patients with acute neck pain. For comparison, however, Hurwitz et al (l8) used the Neck Disability Index, which uses a point scale of 0 to 50 to evaluate a mixed group of neck pain patients. The researchers noted a decrease of more than 6 points at 6-month follow-up. In a study of CMT and chronic neck pain, Jordan et al (17) rated disability using a scale with a maximal point score of 30. Self-reported disability showed improvements that showed approximately a 50% reduction. This compares to more than a 50% reduction in this current study.
Women had a higher proportion of activity restriction than men, which was determined to be statistically significant. This finding is similar to what has been apparent in outcome studies of automobile crash–related neck injuries. In effect, women sustained long-term consequences more often than men after whiplash injuries. (29)