A randomized clinical trial of chiropractic treatment and self-management in patients with acute musculoskeletal chest pain: 1-year follow-up.
OBJECTIVE
We have previously reported short-term follow-up from a pragmatic randomized clinical trial comparing 2 treatments for acute musculoskeletal chest pain: (1) chiropractic treatment and (2) self-management. Results indicated a positive effect in favor of the chiropractic treatment after 4 and 12 weeks. The current article investigates the hypothesis that the advantage observed at 4 and 12 weeks would be sustained after 1 year. In addition, we describe self-reported consequences of acute musculoskeletal chest pain at 1-year follow-up.


METHODS
In a nonblinded, randomized controlled trial undertaken at an emergency cardiology department and 4 outpatient chiropractic clinics, 115 consecutive patients with acute chest pain of musculoskeletal origin were included. After the baseline evaluation, patients were randomized to 4 weeks of either chiropractic treatment or self-management, with posttreatment questionnaire follow-up 52 weeks later. The primary outcome measures were change in pain intensity (11-point box numerical rating scale) and self-perceived change in pain (7-point ordinal scale).


RESULTS
Both groups experienced decreases in pain, positive global, self-perceived treatment effect, and increases in the 36-Item Short Form Health Survey scores. No statistically significant differences were observed between groups at the 1-year follow-up, and we could not deduce a common trend in favor of either intervention.


CONCLUSIONS
At the 1-year follow-up, we found no difference between groups in terms of pain intensity and self-perceived change in chest pain in the first randomized clinical trial assessing chiropractic treatment vs minimal intervention for patients with acute musculoskeletal chest pain. Further research into health care utilization and use of prescriptive medication is warranted.
Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Part of Clinical Locomotion Network, Odense, Denmark. m.jensen@nikkb.dk
Mette J
MJ
Stochkendahl
Henrik W
HW
Christensen
Werner
W
Vach
Poul F
PF
Høilund-Carlsen
Torben
T
Haghfelt
Jan
J
Hartvigsen
D002637:Chest Pain / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D026882:Manipulation, Chiropractic; D059352:Musculoskeletal Pain / Q000628:therapy*; D012648:Self Care; D013997:Time Factors