A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain

Daniel C. Cherkin, Richard (Rick) Deyo, Michele Battié, Janet Street, William Barlow

Research output: Contribution to journalArticle

445 Citations (Scopus)

Abstract

Background and Methods: There are few data on the relative effectiveness and costs of treatments for low back pain. We randomly assigned 321 adults with low back pain that persisted for seven days after a primary care visit to the McKenzie method of physical therapy, chiropractic manipulation, or a minimal intervention (provision of an educational booklet). Patients with sciatica were excluded. Physical therapy or chiropractic manipulation was provided for one month (the number of visits was determined by the practitioner but was limited to a maximum of nine); patients were followed for a total of two years. The bothersomeness of symptoms was measured on an 11-point scale, and the level of dysfunction was measured on the 24-point Roland Disability Scale. Results: After adjustment for base-line differences, the chiropractic group had less severe symptoms than the booklet group at four weeks (P=0.02), and there was a trend toward less severe symptoms in the physical-therapy group (P=0.06). However, these differences were small and not significant after transformations of the data to adjust for their non- normal distribution. Differences in the extent of dysfunction among the groups were small and approached significance only at one year, with greater dysfunction in the booklet group than in the other two groups (P=0.05). For all outcomes, there were no significant differences between the physical- therapy and chiropractic groups and no significant differences among the groups in the numbers of days of reduced activity or missed work or in recurrences of back pain. About 75 percent of the subjects in the therapy groups rated their care as very good or excellent, as compared with about 30 percent of the subjects in the booklet group (P

Original languageEnglish (US)
Pages (from-to)1021-1029
Number of pages9
JournalNew England Journal of Medicine
Volume339
Issue number15
DOIs
StatePublished - Oct 8 1998
Externally publishedYes

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Chiropractic Manipulation
Pamphlets
Low Back Pain
Group Psychotherapy
Chiropractic
Sciatica
Normal Distribution
Therapeutics
Back Pain
Health Care Costs
Cost-Benefit Analysis
Primary Health Care
Recurrence

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. / Cherkin, Daniel C.; Deyo, Richard (Rick); Battié, Michele; Street, Janet; Barlow, William.

In: New England Journal of Medicine, Vol. 339, No. 15, 08.10.1998, p. 1021-1029.

Research output: Contribution to journalArticle

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