A randomized trial of medical care with and without physical therapy and chiropractic care with and without physical modalities for patients with low back pain: 6-month follow-up outcomes from the UCLA low back pain study
| Autor: | Eric L. Hurwitz, Fei Yu, Alan H. Adams, Hal Morgenstern, Philip Harber, Gerald F. Kominski, Thomas R. Belin |
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| Rok vydání: | 2002 |
| Předmět: |
medicine.medical_specialty
Randomization medicine.medical_treatment Anti-Inflammatory Agents law.invention Randomized controlled trial law Surveys and Questionnaires Health care Outcome Assessment Health Care medicine Humans Orthopedics and Sports Medicine Exercise Physical Therapy Modalities Pain Measurement Analgesics Rehabilitation business.industry Manipulation Chiropractic Managed Care Programs Chiropractic Low back pain Combined Modality Therapy Los Angeles Clinical trial Treatment Outcome Neuromuscular Agents Physical therapy Managed care Neurology (clinical) medicine.symptom business Low Back Pain Follow-Up Studies |
| Zdroj: | Spine. 27(20) |
| ISSN: | 1528-1159 |
| Popis: | Study design A randomized clinical trial. Objectives To compare the effectiveness of medical and chiropractic care for low back pain patients in managed care; to assess the effectiveness of physical therapy among medical patients; and to assess the effectiveness of physical modalities among chiropractic patients. Summary of background data Despite the burden that low back pain places on patients, providers, and society, the relative effectiveness of common treatment strategies offered in managed care is unknown. Methods Low back pain patients presenting to a large managed care facility from October 30, 1995, through November 9, 1998, were randomly assigned in a balanced design to medical care with and without physical therapy and to chiropractic care with and without physical modalities. The primary outcome variables are average and most severe low back pain intensity in the past week, assessed with 0 to 10 numerical rating scales, and low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire. Results Of 1,469 eligible patients, 681 were enrolled; 95.7% were followed through 6 months. The mean changes in low back pain intensity and disability of participants in the medical and chiropractic care-only groups were similar at each follow-up assessment (adjusted mean differences at 6 months for most severe pain, 0.27, 95% confidence interval, -0.32-0.86; average pain, 0.22, -0.25-0.69; and disability, 0.75, -0.29-1.79). Physical therapy yielded somewhat better 6-month disability outcomes than did medical care alone (1.26, 0.20-2.32). Conclusions After 6 months of follow-up, chiropractic care and medical care for low back pain were comparable in their effectiveness. Physical therapy may be marginally more effective than medical care alone for reducing disability in some patients, but the possible benefit is small. |
| Databáze: | OpenAIRE |
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