Back pain and satisfaction with chiropractic treatment: what role does the physical outcome play?
OBJECTIVE
This study sought to determine what functional and affective outcomes had the most predictive value for overall satisfaction and improvement in patients seeking chiropractic treatment of low back pain.


METHODS
Baseline questionnaires were completed by 965 patients seeking chiropractic help for low back pain, with blinded follow-up at 6 weeks. Patients were asked about effects on pain, anxiety, normal activity, work, depression, lifestyle, satisfaction, and overall improvement. Stepwise multiple regression analyses were used to evaluate the contribution of change scores to overall improvement and satisfaction. A 2-stage block regression was conducted to find out what additional factors besides overall improvement predicted patient satisfaction.


RESULTS
There were weak to moderate, but highly significant, relationships between the change scores and both improvement and satisfaction. However, most of the variance (57%) in the latter was explained by overall improvement and a very small amount (0.5%) by improvements in activity, leaving nearly 43% unexplained by any of the variables. Pain, work, and ability to control pain together predicted 27% of the variance in overall improvement. No other variables predicted this, leaving 73% of the variance unexplained.


CONCLUSIONS
Pragmatic rather than affective variables played some part in predicting satisfaction through global improvement in these patients. This should help to inform future interpretation of clinical trials of chiropractic treatments for back pain. However, the nature of the "unknown" components needs further investigation. There are initial indications in the literature that information giving, and the reconfiguration of patients' perceptions of the problem, may contribute to patient satisfaction generally. Further work is needed to confirm this and to establish where such interventions can also contribute to overall improvement.
Breen
Alan
A
Institute for Musculoskeletal Research and Clinical Implementation, Anglo-European College of Chiropractic, Bournemouth, Dorset, United Kingdom. imrci.abreen@aecc.ac.uk
Breen
Rosanna
R
D000203:Activities of Daily Living; D001294:Attitude to Health; D001416:Back Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D003625:Data Collection; D005500:Follow-Up Studies; D006801:Humans; D026882:Manipulation, Chiropractic / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D016037:Single-Blind Method; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology