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Chiropractic Journal of Australia : December 2011
Chiropractic Journal of Australia Volume 41 Number 4 December 2011 121 CHIROPRACTIC CARE IMPROVES CHRONIC LBP KHAUV • JOHN supported by a number of studies that use either the Original or Modifed/Revised Oswestry Disability Questionnaire (ODQ) to report on chiropractic care and cLBP patients.10,11,32 Table 1 illustrates the results of the current study and current articles found on PubMed. When the other studies utilized the 100-point Oswestry scale, their scores were converted (by dividing the scores by 2) to a 50-point scale to be consistent with the current study. From Table 1, there are three differences found in the other studies and the current study: the number of subjects, the percentage of net change of Oswestry scores, and the number of adjustments. The current study had 117 subjects, making it the second highest number of subjects behind Haas11 with 527. Zaproudina10 had the third highest at 59 subjects while the other followed in the twenties and teens. The current study and Haas11 were able to achieve a high number of participants by incorporating multi-center, practiced-based research. The current study achieved the highest net percentage change among the Modifed or Revised ODQ with 49.66% (P < .01) as compared to 43.12% (P = .000) by Haas,11 and a non statistical signifcant 19.80% by McMorland and Suter.32 While the current study only offered DNFT chiropractic care for their subjects, Haas11 described chiropractic care in the study as "spinal manipulation, physical therapy, exercise plan, and self-care advice." Giles and Muller33 did achieve a 50% (P = .01) reduction in the Original ODQ after a 9-week intervention of 2 treatments per week. Study Limitations While the results from this study appear positive, there were limitations that need to be addressed. There was no randomization or use of a control group. The study also lacked the comparison to other treatment modalities such as exercise, medication, massage, physical therapy, or self-care education to compare the results against. Social desirability on self-reported questionnaires is an important bias to address with chronic pain research,40 especially when the subjects completed the pre-and post-questionnaires within the practice setting at which they received care but not in the presence of the chiropractor. The use of the Marlowe-Crowne Social Desirability Scale41 should be included in future studies with cLBP and the use of the MOPD, the COOP charts and the PI-NRS. The use of the randomized controlled trial (RCT) study design, reducing social desirability by study design, and performing sensitivity analysis of "non-completers" would minimize many of these biases and improve these fndings. CONCLUSION This study supports the few other studies in current literature suggesting that chiropractic care can improve cLBP by decreasing pain intensity and functional disability while improving overall health. DNFT chiropractic care achieved these results with 6 adjustments. The study is not without limitations that can be addressed in a study design with RCT. Future RCT studies with DNFT chiropractic care against a number of different modalities and placebo would be desirable to confrm these fndings. ACKNOWLEDGEMENTS We would like to acknowledge Dale Johnson, PhD and Nadine Kadey for critically revising and editing the manuscript and the librarians at Life Chiropractic College West, Barbara Delli Gatti, Annette Osenga and Patricia Brack, for their countless hours of literature research support. REFERENCES 1. Deyo RA, Phillips WR: Low back pain. A primary care challenge. Spine. 1996 Dec 15;21(24):2826-32. 2. Cedraschi C, Robert J, Goerg D, Perrin E, Fischer W, Vischer TL. Is chronic non-specifc low back pain chronic? Defnitions of a problem and problems of a defnition.Br J Gen Pract. 1999 May;49(442):358- 62. 3. Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wal- lace AS, Castel LD, Kalsbeek WD, Carey TS. The rising prevalence of chronic low back pain. Arch Intern Med. 2009 Feb 9;169(3):251- 58. 4. Kinkade S: Evaluation and treatment of acute low back pain. Am Fam Physician. 2007 Apr 15;75(8):1181-8. 5. Dunn KM, Croft PR: Epidemiology and natural history of low back pain. Eura Medicophys. 2004 Mar;40(1):9-13. 6. Croft PR, Macfarlane GJ, Papageorgiou AC, Thomas E, Silman AJ: Outcome of low back pain in general practice: a prospective study. BMJ. 1998 May 2;316(7141):1356-9. Table 1 Modifed Oswestry Disability Questionnaire (MODQ) scores at baseline and at 4 weeks for current study and current literature. Study n P value Baseline MODQ 4-week MODQ Net Change Net Change % Number of Adjustments Current Study * 120 0 17.72 8.92 -8.8 49.66% 6 Haasetal11*† 527 0 19.25 10.95 -8.3 43.12% Missing McMoreland & Suter31 *‡ 14 No sig. 27.1 21.73 -5.37 19.80% 12 Zaproudina et al 10 § 59 0.069 9.95 6.15 -3.8 38.19% 3to5 Giles & Muller32 § 25 0.o1 12 6 (9 wks) -6 50% 18 * Used Modifed or Revised Oswestry Disability Questionnaire † Chronic pain was defned as a current episode 7 weeks or longer ‡ Chronic pain was defned at > 6 months § Used Original Oswestry Disability Questionnaire, Converted to 50 points scale
CJA March 2012