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Chiropractic Journal of Australia : December 2011
118 Chiropractic Journal of Australia Volume 41 Number 4 December 2011 Low back pain (LBP) is the second leading symptom- related reason to seek medical care and the most common spinal pain.1 Patients suffering low back pain longer than 3 months are conventionally categorized as chronic low back pain (cLBP) sufferers.2 Freburger et al3 reported that chronic low back pain prevalence rose from 3.9% in 1992 to 10.2% in 2006. While it is commonly accepted that most LBP cases resolve quickly,4 a growing number of studies challenge this belief.5-7 Among them, Croft et al6 reported 25% of the 463 patients that sought primary care still suffered low back pain after 12 months. Katz7 reported cLBP with associated disability makes up 5% of the cases with low back pain yet it accounts for 75% of the total costs related to the disorder. The same study reported the total cost being over $100 billion annually in the United States with two-thirds coming from indirect costs, which include lost wages and reduced productivity. In 2007, the American College of Physicians and the American Pain Society published clinical guidelines regarding the diagnosis and treatment of low back pain including seven recommendations.8 One of the recommendations under consideration was "nonpharmacologic therapy with proven benefts” which included spinal manipulation for patients with unresolved chronic low back pain after an initial trial of self-care and medications; but the recommendations were rated as weak due to only moderate quality of the evidence available in current literature. Evidence for effectiveness of chiropractic adjustments for cLBP is inconclusive or weak.9 Some studies have positive outcomes10,11 while others cannot conclude that spinal manipulation is more effective than placebo, exercise, massage, and other non-invasive procedures.12-15 A 2011 systematic review of interventions for cLBP concluded high-quality evidence suggests no clinical relevant difference between spinal manipulative therapy and other interventions for reducing pain and improving function.16 Health-related Quality of Life Improvements in Adult Patients with Chronic Low Back Pain under Low-force Chiropractic Care: A Practice-based Study KIM B. KHAUV and CHRISTOPHER JOHN ABSTRACT: Background: Chronic Low Back Pain (cLBP) costs the United States over $100 billion annually. Primary Study Objective: This study reports pain intensity, general health and functional disability outcomes after 4-weeks of chiropractic care for cLBP patients. Methods/Design: A prospective case series, nonrand- omized, non-controlled, practice-based study. Setting: 22 private chiropractic practices in the US. Subjects: 131 adult cLBP patients, 68 males (53.5%), mean age of 46.75 with chief complaints of cLBP (LBP ≥ 3 months) with mean duration of 11 years. Intervention: Each patient received 6 offce visits over a 4-week period with doctors following Directional Non-Force Technique (DNFT) chiropractic protocols. Outcome Measures: The Dartmouth COOP charts (general health), Modifed Oswestry Disability Questionnaire (MODQ) (functional disability), and an 11-point Pain Intensity Numerical Rating Scale (PI-NRS) for pain. Results: The pre and post-care mean scores of COOP were 13.16 (95% CI 9.33 -- 16.99, P < 0.01) and 10.52 (CI 6.98 -- 14.06, P < 0.01) respectively, 20.06% improvement. The MODQ were 17.72 (CI 11.02 -- 24.42, P < 0.01) and 8.92 (CI 2.30 -- 15.54, P < 0.01), 49.66% improvement in functional disability. The PI-NRS was 18.18 (CI 12.26 -- 24.10, P < 0.01) and 10.60 (CI 3.80 -- 6.80, P < 0.01), improving 41.69%. Conclusions: Improvements appeared to be signifcant on general health, functional disability, and pain intensity after an intervention of 4-weeks with 6 visits of DNFT chiropractic care. These fndings merit a randomized control trial of chiropractic versus a control group or other treatment modalities in the future. INDEX TERMS: (MeSH): CHIROPRACTIC; COMPLEMENTARY THERAPIES; LOW BACK PAIN; MANIPULATION, CHIROPRAC- TIC. (Other): CHRONIC LOW BACK PAIN; PRACTICE-BASED RESEARCH; RECURRENT LOW BACK PAIN. Chiropr J Aust 2011; 41: 118-22. Kim B. Khauv, DC, MPH Assistant Professor Life Chiropractic College West Hayward, California Christopher John, DC Proprietor of DNFT® Chiropractic Private Practice Beverly Hills, California CONFLICT OF INTEREST STATEMENT: Dr. Kim Khauv has received speaking and consultation fees from DNFT chiropractic. Dr. Chris John is the proprietor of DNFT® chiropractic. Received: 27 May 2011, Revised version accepted: 12 October 2011.
CJA March 2012