Scientific British Study

Chiropractic Care vs. Hospital Outpatient Management on Low Back Pain

The abstract of the study, printed in the June 2, 1990 issue of the British Medical Journal, gives a good summary of the extensive, prospective study entitled “Low back Pain and Mechanical origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment.”

Objective: To compare Chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin.

Design: Randomized controlled trail. Allocation to Chiropractic or hospital management by minimization to establish groups for analysis of results according to initial referral clinic, length of current episode, history and severity of back pain. Patients were followed up for up to two years.

Setting: Chiropractic and hospital outpatient clinics in 11 centers.

Patients: 741 patients aged 18-65 who had no contraindication to manipulation and who had not been treated within the past month.

Interventions: Treatment at the discretion of the Chiropractors, who had used Chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilization or manipulation, or both.

Main Outcome Measures: Changes in the score on the Oswestry pain disability questionaire and in the results of the tests of straight leg raising and lumbar flexion.

Results: Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7 percent points on the Oswestry scale was seen at two years. The benefit of Chiropractic treatment became more evident throughout the follow-up period. Secondary outcome measures also showed that Chiropractic was more beneficial.

Conclusions: For patients with low back pain in whom manipulation is not contraindicated Chiropractic almost certainly confers worthwhile long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing Chiropractic into NHS practice should be considered.

Results suggest that there might be a reduction of some 290,000 days in sickness absence during two years, saving about $21,580,000 in output and $4,814,000 in social security payments.