title: Outcomes for chronic neck and low back pain patients after manipulation under anesthesia: a prospective cohort study.
abstract: BACKGROUND
  The purpose of this study was to investigate outcomes of chronic patients unresponsive to previous spinal manipulative therapy subsequently treated with manipulation under anesthesia (MUA).
  
  
  METHODS
  A prospective outcome cohort study was performed on 30 patients who had not improved with previous treatment and who underwent a single MUA by a doctor of chiropractic. The numeric rating scale for pain (NRS) and Bournemouth Questionnaire (BQ) were collected at 2 weeks and 1 day before MUA. At 2 and 4 weeks after MUA, the Patient's Global Impression of Change, NRS, and BQ were collected. The intraclass correlation coefficient evaluated stability before treatment. Percentage of patients "improved" was calculated at 2 and 4 weeks. Wilcoxon test compared pretreatment NRS and BQ scores with posttreatment scores. Mann-Whitney U test compared individual questions on the BQ between improved and not improved patients. Logistic regression compared BQ questions to "improvement."
  
  
  RESULTS
  Good stability of NRS and BQ scores before MUA (intraclass correlation coefficient=0.46-0.95) was found. At 2 weeks, 52% of the patients reported improvement with 45.5% improved at 4 weeks. Significant reductions in NRS scores at 4 weeks (P=.01) and BQ scores at 2 (P=.008) and 4 weeks (P=.001) were reported. Anxiety/stress levels were significantly different at 2 and 4 weeks between improved and not improved patients (P=.007). None of the BQ questions were predictive of improvement.
  
  
  CONCLUSIONS
  Approximately half of patients previously unresponsive to conservative treatment reported clinically relevant improvement at 2 and 4 weeks post-MUA.
authors.affiliation: Professor, Chiropractic Medicine and Radiology Departments, Orthopaedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland. Electronic address: cynthia.peterson@balgrist.ch.
authors.forename: Cynthia K
authors.initials: CK
authors.lastname: Peterson
authors.affiliation: Professor, Chiropractic Medicine Department, Orthopaedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland.
authors.forename: B Kim
authors.initials: BK
authors.lastname: Humphreys
authors.affiliation: Chiropractic Intern and Masters Student, Chiropractic Medicine Department, Orthopaedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland.
authors.forename: Regina
authors.initials: R
authors.lastname: Vollenweider
authors.affiliation: Chiropractic Intern and Masters Student, Chiropractic Medicine Department, Orthopaedic University Hospital Balgrist, University of Zürich, Zürich, Switzerland.
authors.forename: Michel
authors.initials: M
authors.lastname: Kressig
authors.affiliation: Private Practice, Zürich, Switzerland.
authors.forename: Rolf
authors.initials: R
authors.lastname: Nussbaumer
mesh_terms: D000328:Adult; D000758:Anesthesia; D059350:Chronic Pain / Q000628:therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods*; D019547:Neck Pain / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Anesthesia; Chiropractic; Outcomes Research; Spinal Manipulation