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.
METHODS
A randomized clinical trial.


OBJECTIVE
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.


BACKGROUND
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.
Hurwitz
Eric L
EL
Department of Epidemiology, University of California-Los Angeles School of Public Health, Los Angeles, California 90095-1772, USA. ehurwitz@ucla.edu
Morgenstern
Hal
H
Harber
Philip
P
Kominski
Gerald F
GF
Belin
Thomas R
TR
Yu
Fei
F
Adams
Alan H
AH
D000700:Analgesics / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015444:Exercise; D005500:Follow-Up Studies; D006801:Humans; D015141:Los Angeles; D017116:Low Back Pain / Q000628:therapy*; D008329:Managed Care Programs / Q000592:standards*; D026882:Manipulation, Chiropractic / Q000706:statistics & numerical data; D009465:Neuromuscular Agents / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000700:Analgesics; D000893:Anti-Inflammatory Agents; D009465:Neuromuscular Agents