Table 1. Characteristics of the clinical effectiveness studies included into the quantitative synthesis of Chiropractic care for non-specific low back pain.
First Author, Year, Country and Setting | Participants and Indication | Comparative Treatments | Follow-up assessment | Relevant outcomes |
---|---|---|---|---|
- Bronfort 2011[50] - USA, University research clinic in Bloomington, MN |
18 to 65 years old with mechanical LBP of at least 6-week duration with or without radiating pain. (sub-acute/chronic) | • Chiropractic care once to twice per week for 15 to 30 minutes including: SMT and few minutes of soft-tissue massage, ice, or heat (n = 100). • Supervised exercise therapy provided by exercise therapists (n = 100). |
• Total: 1 year • Relevant for this review: 1 month (week 4), 3 months (week 12), 12 months (week 52) |
- Functional status (Roland-Morris 0–23) - Health related quality of life (SF-36 physical and mental scales) - Global improvement (1 = complete improvement, 9 = twice as bad) - Adverse events |
- Cherkin 1998 [51] - USA, Group Health Cooperative of Puget Sound (HMO), Seattle, WA |
Patients 20 to 64 years of age who saw their primary care physician for low back pain and who still had pain seven days later. (mix/not specified) | • Chiropractic care: according to usual clinicians procedures including recommendations about exercise and activity restrictions (n = 122). • Physical therapy care: provided by therapists trained by the McKenzie Institute faculty. Subjects received McKenzie’s Treat Your Own Back book and a lumbar-support cushion. Therapists were instructed to avoid therapies such as heat, ice, transcutaneous electrical nerve stimulation, ultrasonography, and back classes (n = 133). |
• Total: 2 years • Relevant for this review: 1 month (week 4), 3 months (week 12)* |
- Functional status (Roland-Morris 0–24) - Adverse events |
- Herzog 1991 [52] - Canada, Unknown setting in Calgary, Alberta |
Ambulatory patient between 18 and 50 years old with a sacroiliac joint problem since at least one month. (sub-acute/chronic) | • Chiropractic care: SMT and the optimal treatment modality to the discretion of the chiropractor** for 10 sessions over 4 week (n = 16). • Physical therapy care: back school therapy for 10 sessions over 4 week (n = 13). |
• Total: 1 month (week 4, treatment completion) • Relevant for this review: none |
- Actual pain (VAS 0–10) - Functional status (Oswestry 0–100) |
- Hurwitz 2002 [45, 46] - USA, 3 Primary Care Centers of a 100 000 member health-care network based in southern California |
HMO member of at least 18 years old with a complaint of low back pain with or without leg pain. (mix/not specified) | • Chiropractic Care: SMT, instruction in strengthening and flexibility exercises, and instruction in proper back care (n = 169). • Medical care: One or more of the following: instruction in proper back care and strengthening and flexibility exercises; prescriptions for pain killers, muscle relaxants, anti-inflammatory agents, and other medications used to reduce or eliminate pain or discomfort; and recommendations regarding bed rest, weight loss, and physical activities (n = 170). |
• Total: 1.5 year • Relevant for this review: 1 month (week 6), 12 months |
- Average pain (VAS 0–10) - Functional status (Roland-Morris 0–24)Adverse events |
- Meade 1990 [43, 44] - United-Kingdom, 11 centres with hospital and chiropractic clinics within a reasonable distance |
Patients 18 to 65 years of age with low back pain of mechanical origin. (mix/not specified) | • Chiropractic care: at the discretion of the chiropractor for a maximum of 10 treatments over one year. The treatments were intended to be concentrated within the first 3 months (n = 384). • Physiotherapy care: within hospital outpatient clinics (n = 357). |
• Total: 3 years • Relevant for this review: 1 month (week 6), 1 year |
- Functional status (Oswestry 0–100) - Global improvement (Number of patients partially or complete relieved) |
- Petersen 2011[53] - Denmark, Primary care specialist center in Copenhagen |
Patients of 18 and 60 years of age suffering from LBP with or without leg pain since more than 6 weeks. (sub-acute/chronic) | • Chiropractic care: all type of manual technique including SMT and myofascial trigger-point massage at the discretion of the chiropractor for a maximum of 15 treatments in a 12 weeks period. Mobilizing exercises, alternating lumbar flexion/extension movements, and stretching, were allowed (n = 175). • Physical therapy care: according to the McKenzie treatment protocols. An educational booklet about self-care or a “lumbar roll” for the seated posture were sometimes provided to the patient (n = 175). |
• Total: 12 months (post-treatment completion) • Relevant for this review: 3 months (treatment completion (12 week)), 12 months (post-treatment completion) |
- Functional status (Roland-Morris 0–23) - Back and leg pain (0–60 scale from 6 VAS (actual, worst, average)) - Health related quality of life (SF-36 general health perception and mental health scales (0–100)) - Global improvement (Number of patients scoring completely cured_ or much improved on a 6-point Likert scale (much worse, worsened, no change, improved, much improved, completely cured)) |
HMO: Health Maintenance Organization; SMT: Spinal Manipulative Therapy; VAS: Visual Analog Scale
* Results for the one-year follow-ups were only provided graphically and could not be used for this review
** Precisions regarding the chiropractic care modalities obtained from communication with the study authors