This study appeared in a recent issue of the Spine Journal which is the official journal of the North American Spine Society. In addition, it was authored by researchers affiliated with UBC and the International Collaboration on Repair Discoveries (ICORD). The study wanted to compare the effectiveness of clinically supported 'guidelines' for treatment of acute, mechanical low back pain versus the 'usual care' patients would receive from their family doctors.
Clinical practice guidelines (CPG's) are meant to serve as a 'map' of sorts for doctors in regards to treatment of their patients with specific conditions. CPG's help a doctor determine what's the best treatment option available based on clinical trials and evidence collected over time. Interestingly enough, CPG's for the treatment of low back pain patients have been around for some time now but evidence shows that most patients who see their family doctors for this condition do not get treatment based on these guidelines.
So now the question is, "...does it make a difference whether a patient is treated according to Clinical Practice Guidelines (CPG's) versus regular care from their family doctors?" In short, this study has found that yes, it does make a significant difference.
For clarification, patients were divided up into two different groups. One group was treated according to CPG's which included; acetominophen, a light exercise program, 4 weeks of Chiropractic treatments and return to work in 8 weeks time. The second group was treated by their family doctors, whichever way they 'seemed fit'. The type of treatment measures the family doctor group received included; prescription pain relievers, massage therapists, kinesiologists and/or physiotherapists. All participants were surveyed at the beginning, then again at 8, 16 and 24 weeks into the trial.
Some important findings include; at 16 weeks, 78% of the patients treated by a family doctor were still taking prescription pain killers on either a daily or 'as needed' basis. At 16 weeks, condition specific improvements, clearly favored the group whose care included Chiropractic.
Another interesting finding was that manipulations/mobilizations that were performed by Physiotherapists were shown to have no clinically worthwhile benefit when compared with advice and acetominophen alone. The difference here can probably be attributed to the difference in education and experience that Chiropractors have when treating patients who are suffering from acute low back pain.
At the last survey performed on participants (at 24 weeks into the study), the difference in improvements in the two groups was found to be "clearly significant" in favor of the CPG's groups care that included Chiropractic compared to the group treated by a family doctor.
It is also important to note that current guideline based care endorses the use of spinal manipulations performed by Chiropractors. Although, several other disciplines including; massage, physiotherapy, physical therapy and kinesiologists may claim that 'spinal manipulations' are included in their care, Chiropractors are still the preferred specialists when it comes to this treatment just based on their education and experience alone.
So if you're suffering from severe back, low-back, hip, neck, shoulder pain, visit my office just off Commercial Drive in East Vancouver. Remember to leave a comment or visit my website here; COMMERCIAL DRIVE - EAST VANCOUVER CHIROPRACTOR; DR. DOMINIC CHAN DC!!!
Notes: The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain.
Spine J. 2010 Dec;10(12):1055-64.
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