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A randomized trial of chiropractic and medical care for patients with low back pain : eighteen-month follow-up outcomes from the UCLA low back pain study . STUDY DESIGN Randomized clinical trial . OBJECTIVES To compare the long-term effectiveness of medical and chiropractic care for low back pain in managed care and to assess the effectiveness of physical therapy and modalities among patients receiving medical or chiropractic care . SUMMARY OF BACKGROUND DATA Evidence comparing the long-term relative effectiveness of common treatment strategies offered to low back pain patients in managed care is lacking . METHODS A total of 681 low back pain patients presenting to a managed-care facility were randomized to chiropractic with or without physical modalities , or medical care with or without physical therapy , and followed for 18 months . The primary outcome variables are low back pain intensity , disability , and complete remission . The secondary outcome is participants ' perception of improvement in low back symptoms . RESULTS Of the 681 patients , 610 ( 89.6 % ) were followed through 18 months . Among participants not assigned to receive physical therapy or modalities , the estimated improvements in pain and disability and 18-month risk of complete remission were a little greater in the chiropractic group than in the medical group ( adjusted RR of remission = 1.29 ; 95 % CI = 0.80-2.07 ) . Among participants assigned to medical care , mean changes in pain and disability and risk of remission were larger in patients assigned to receive physical therapy ( adjusted RR = 1.69 ; 95 % CI = 1.08-2.66 ) . Among those assigned to chiropractic care , however , assignment to methods was not associated with improvement or remission ( adjusted RR = 0.98 ; 95 % CI = 0.62-1.55 ) . Compared with medical care only patients , chiropractic and physical therapy patients were much more likely to perceive improvement in their low back symptoms . However , less than 20 % of all patients were pain-free at 18 months . CONCLUSIONS Differences in outcomes between medical and chiropractic care without physical therapy or modalities are not clinically meaningful , although chiropractic may result in a greater likelihood of perceived improvement , perhaps reflecting satisfaction or lack of blinding . Physical therapy may be more effective than medical care alone for some patients , while physical modalities appear to have no benefit in chiropractic care .
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Intervention_Pharmacological
medical care
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Intervention_Educational
medical and chiropractic care for low back pain
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Intervention_Physical
physical therapy
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Intervention_Psychological
medical
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Intervention_Educational
or chiropractic care
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Intervention_Physical
chiropractic with or without physical modalities
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Intervention_Physical
medical care with or without physical therapy
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Intervention_Physical
physical therapy
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Intervention_Educational
chiropractic care
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Intervention_Educational
chiropractic
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Intervention_Educational
medical and chiropractic care
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Intervention_Physical
Physical therapy
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Outcome_Pain
low back pain
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Outcome_Pain
low back pain intensity
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Outcome_Physical
disability
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Outcome_Pain
complete remission
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Outcome_Physical
low back symptoms
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Outcome_Pain
pain
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Outcome_Physical
disability
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Outcome_Physical
risk of complete remission
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Outcome_Pain
mean changes in pain
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Outcome_Physical
disability
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Outcome_Pain
risk of remission
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Outcome_Pain
pain-free
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Participant_Condition
low back pain
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Participant_Condition
low back pain
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Participant_Condition
low back pain
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Participant_Sample-size
681
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Participant_Condition
low back pain
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Participant_Sample-size
681
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Participant_Sample-size
610