The effects of combined chiropractic interventions on patients with low back pain
Patients often seek chiropractors, but little is known about their effects
Of the available options to treat low back pain (LBP), chiropractic interventions rank as one of the most common in high-income countries like Australia and the U.S. Chiropractors in turn use a combination of different interventions, emphasizing manual treatments like spinal manipulative therapy (SMT), physical therapy modalities, exercise programs, lifestyle modification and other patient education. Though chiropractic interventions are popular, evidence of their effectiveness is limited. Noting this lack of information, a review was created meant to determine the effects of combined chiropractic interventions on pain, disability, back-related function, overall improvement and patient satisfaction in adults with LBP. The overall question to be answered was: “Is combined chiropractic care likely to help a patient with LBP, and if so, how does it compare to other interventions?”
Large pool of studies drastically reduced using inclusion criteria
Only randomized controlled trials (RCTs) that compared chiropractic interventions to other therapies or no therapy were considered, and a total of 3,699 studies were initially screened for inclusion. After applying strict inclusion criteria, this number was reduced to 12 studies involving 2,887 participants with LBP. All studies were then rated for their quality of evidence and assessed for risk of bias and clinical relevance according to a series of questions. Results were categorized into four groups: 1) chiropractic versus other therapies (acute and subacute LBP); 2) chiropractic versus other therapies (chronic LBP); 3) chiropractic versus other therapies (mixed-duration LBP) and 4) chiropractic versus no treatment.
Slight improvements and mixed results insufficient to reach conclusions on interventions
On the whole, combined chiropractic interventions showed no meaningful long-term effects on LBP. In the short- and medium-term, there was minor relief for pain and disability, but no clinically relevant sample sizes were available to substantiate those results and there was a high risk of bias in all studies with a positive result. With regard to chronic or mixed-duration LBP, no evidence was noted for chiropractic over other forms of treatment. Since no conclusive evidence was found to prove chiropractic interventions are an effective intervention for LBP, patients should consider alternatives while additional studies are conducted. Further research with stronger parameters is needed to evaluate these interventions in greater detail, and other interventions like physical therapy should also be given attention as more effective strategies for treating LBP continue to be sought.
-Summarized by Greg Gargiulo
-As reported in the Feb. '11 edition of Spine
