J Gen Intern Med. 2018 Jun 25. doi: 10.1007/s11606-018-4539-y. [Epub ahead of print]
Comparative Effectiveness of Usual Care With or Without
Chiropractic Care in
Patients with
Recurrent Musculoskeletal Back and
Neck Pain.
Elder C1, DeBar L2, Ritenbaugh C3, Dickerson J4, Vollmer WM4, Deyo RA5, Johnson ES4, Haas M6.
Author information
AbstractBACKGROUND:
Chiropractic care is a popular alternative for back and neck pain, with efficacy comparable to usual care in randomized trials. However, the effectiveness of chiropractic care as delivered through conventional care settings remains largely unexplored.
OBJECTIVE:
To evaluate the comparative effectiveness of usual care with or without chiropractic care for patients with chronic recurrent musculoskeletal back and neck pain.
STUDY DESIGN:
Prospective cohort study using propensity score-matched controls.
PARTICIPANTS:
Using retrospective electronic health record data, we developed a propensity score model predicting likelihood of chiropractic referral. Eligible patients with back or neck pain were then contacted upon referral for chiropractic care and enrolled in a prospective study. For each referred patient, two propensity score-matched non-referred patients were contacted and enrolled. We followed the participants prospectively for 6 months.
MAIN MEASURES:
Main outcomes included pain severity, interference, and symptom bothersomeness. Secondary outcomes included expenditures for pain-related health care.
KEY RESULTS:
Both groups' (N = 70 referred, 139 non-referred) pain
scores improved significantly over the first 3 months, with less change
between months 3 and 6. No significant between-group difference was
observed. (severity - 0.10 (95% CI - 0.30, 0.10), interference - 0.07
(- 0.31, 0.16), bothersomeness - 0.1 (- 0.39, 0.19)). After controlling
for variances in baseline costs, total costs during the 6-month
post-enrollment follow-up were significantly higher on average in the
non-referred versus referred group ($1996 [SD = 3874] vs $1086
[SD = 1212], p = .034). Adjusting for differences in age, gender, and
Charlson comorbidity index attenuated this finding, which was no longer
statistically significant (p = .072).
CONCLUSIONS:
We
found no statistically significant difference between the two groups in
either patient-reported or economic outcomes. As clinical outcomes were
similar, and the provision of chiropractic care did not increase costs, making chiropractic services available provided an additional viable option for patients who prefer this type of care, at no additional expense.
KEYWORDS:
alternative medicine; back pain; chiropractic; chronic musculoskeletal pain; comparative effectiveness; complementary and integrative medicine; managed care; neck pain; primary care; propensity scoring; spinal manipulation
PMID:29943109DOI:10.1007/s11606-018-4539-y
