Adams Chiropractic, "Go Where The Pros Go"

Scientific Articles

 

Chiropractic for Chronic LBP: Maintenance Care Better Than Short-Term Therapy


Insurance companies, medical doctors and other health care providers who question the value of chiropractic maintenance care, particularly for low back pain, should consider findings from a new study published in the prestigious medical journal, Spine, which asks (and then answers) the question, "Does Maintained Spinal Manipulation Therapy for Chronic Non-Specific Low Back Pain Result in Better Long-Term Outcome?"


 The study suggests patients with low back pain of at least six months duration experience greater improvement following one month (12 treatments) of spinal manipulative therapy,(chiropractic care) followed by "maintenance spinal manipulation" every two weeks for nine months than subjects who receive one month of SMT only (12 treatments)…
Patients in the manipulation and manipulation-plus-maintenance groups improved with respect to pain and disability after one month compared to the untreated group, but after 10 months, only the group receiving maintenance care reported significant, long-term improvement. The one-month-only group's who did not receive “maintenance” care showed a return of their pain and disability scores to "near pretreatment level."…
Measurements of spine flexion and lateral bending also revealed sustained improvements in subjects receiving maintenance SMT, while improvements in the no-maintenance group during the initial phase of care decreased to near the pretreatment level by the end of the second phase.

Source: Senna MK, Machaly SA. Spine (published ahead of print), Jan. 17, 2011. doi: 10.1097/BRS.0b013e3181f5dfe0

Lower disability recurrence when workers' comp patients receive DC maintenance care vs. care by PTs or MDs.


A study published in the April 2011 issue of the Journal of Occupational and Environmental Medicine suggests that when it comes to work-related low back pain, the risk of disability recurrence is lower for patients treated primarily ("only or mostly") by a doctor of chiropractic than patients treated only/mostly by a physical therapist or a physician. The study defined recurrence in terms of disability following return to work, while patients were under "health maintenance care" by their provider. From a cost perspective, the study also found that average costs of care per disability episode and during the "health maintenance phase" following return to work were higher for patients with recurrent episodes of LBP compared to those with no such recurrence.
 
A large insurance company representing an estimated 10 percent of U.S. workers' compensation cases provided data for the study. Low back pain cases (11,420 new cases of nonspecific LBP) were identified via the company's administrative records and all claimants were tracked from the initial date of injury until one year following the first episode of disability. Claimants who had filed a workers' compensation claim for nonspecific LBP in the prior year were identified and excluded, allowing for evaluation of new-onset cases of nonspecific LBP only (894 cases; average age: 41 years).

Likelihood of Recurrence
"Provider type during the health maintenance care period was significantly associated with recurrent disability ... with the only or mostly physical therapy group having the highest proportion of recurrent disability (16.9%) and the only or mostly chiropractor and the no health maintenance care groups having the lowest proportion of recurrent disability (6.5% and 5.5%, respectively)." More than 12 percent (12.5%) of patients receiving care from a physician experienced recurrent disability.

Authors' Conclusion
"After controlling for demographic factors and multiple severity indicators, patients suffering nonspecific work-related LBP who received health services mostly or only from a chiropractor had a lower risk of recurrent disability than the risk of any other provider type. Even without an improvement in days until recurrent disability, our findings seem to support the use of chiropractic services, as chiropractor services generally cost less than services from other providers. If a lower rate of disability recurrence in work-related LBP cases for chiropractors [holds true], it is important to identify the mechanism of action."

Chiropractic Maintenance Care
The Cifuentes, et al., findings come on the heels of the Senna, et al., study in Spine that found chronic LBP patients who received nine months of maintenance spinal manipulative therapy following one month of treatment reported significant improvement in pain and disability. Patients who received only the initial month of treatment reported diminishing improvement over time, with pain and disability scores returning essentially to pretreatment levels after 10 months.

Access the complete workers' comp study in the print issue of JOEM or online: Cifuentes M, Willetts J, Wasiak R. Health maintenance care in work-related low back pain and its association with disability recurrence. JOEM, April 2011;53(4):396-404.