title: Second Prize: The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: findings from the UCLA low back pain study.
abstract: BACKGROUND
  Although chiropractors often use physical modalities with spinal manipulation, evidence that modalities yield additional benefits over spinal manipulation alone is lacking.
  
  
  OBJECTIVE
  The purpose of the study was to estimate the net effect of physical modalities on low back pain (LBP) outcomes among chiropractic patients in a managed-care setting.
  
  
  METHODS
  Fifty percent of the 681 patients participating in a clinical trial of LBP treatment strategies were randomized to chiropractic care with physical modalities (n = 172) or without physical modalities (n = 169). Subjects were followed for 6 months with assessments at 2, 4, and 6 weeks and at 6 months. The primary outcome variables were average and most severe LBP intensity in the past week, assessed with numerical rating scales (0-10), and low back-related disability, assessed with the 24-item Roland-Morris Disability Questionnaire.
  
  
  RESULTS
  Almost 60% of the subjects had baseline LBP episodes of more than 3 months' duration. The 6-month follow-up was 96%. The adjusted mean differences between groups in improvements in average and most severe pain and disability were clinically insignificant at all follow-up assessments. Clinically relevant improvements in average pain and disability were more likely in the modalities group at 2 and 6 weeks, but this apparent advantage disappeared at 6 months. Perceived treatment effectiveness was greater in the modalities group.
  
  
  CONCLUSIONS
  Physical modalities used by chiropractors in this managed-care organization did not appear to be effective in the treatment of patients with LBP, although a small short-term benefit for some patients cannot be ruled out.
authors.affiliation: UCLA School of Public Health, Department of Epidemiology, Los Angeles, Calif. 90095-1772, USA. ehurwitz@ucla.edu
authors.forename: Eric L
authors.initials: EL
authors.lastname: Hurwitz
authors.forename: Hal
authors.initials: H
authors.lastname: Morgenstern
authors.forename: Philip
authors.initials: P
authors.lastname: Harber
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Kominski
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Belin
authors.forename: Fei
authors.initials: F
authors.lastname: Yu
authors.forename: Alan H
authors.initials: AH
authors.lastname: Adams
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Kominsky
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D002684:Chiropractic / Q000592:standards*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008329:Managed Care Programs; D020393:Manipulation, Spinal / Q000592:standards*; D008875:Middle Aged; D012044:Regression Analysis; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome