The outcome of a Medical Research Council trial at the Medical
College of St. Bartholomew's Hospital in London, England, comparing chiropractic with conventional hospital treatment for low back pain, reported that those patients treated by chiropractic "derive
more benefit and long term satisfaction than those treated by
hospitals."
The results of the study, "Randomised comparison of chiropractic
and hospital outpatient management for low back pain: results from
extended follow up," were published in the Aug. 4, 1995 British
Medical Journal.1
Professor Thomas Meade, and colleagues at the Epidemiology and
Medical Care Unit, using the Oswestry questionnaire, compared the
progress of 741 low back pain patients (undergoing either
chiropractic or hospital treatment) for levels of pain, daily
activities, and satisfaction with their treatment. The numbers
revealed that during the three years, 29 percent more improved
under chiropractic care than those treated by hospital care.
"The beneficial effect of chiropractic on pain was particularly
clear," the authors stated.
Chiropractic patients also expressed greater general satisfaction
with their treatment, slept better, and were able to sit for longer
periods. The study further found that, in general, chiropractic
patients experienced an improved quality of life following
treatment.
This study is a follow up of the 1990 Meade et al. study.2 At the
time of the 1990 report, not all the 741 patients (ages 18-64) had been
in the trial for more than six months. The 1995 follow-up study
presents the full results for all those patients, for which data
was available, up to three years.
"The Medical Research Council trial shows that patients with back
pain can expect better results from their local chiropractors than
from their local hospital," says Ian Hutchinson, president of the
British Chiropractic Association. "Fortunately, the value of
chiropractic is being increasingly recognised, and I hope that
following the trial results, NHS purchasers and chiropractors can
now arrange for more patients to benefit from chiropractic
treatment," he said.
The scores of the new study on pain intensity before treatment and
at the various follow-up periods show a significant improvement in
pain "in those treated by chiropractic, including the changes early
on -- that is, at six weeks and six months, when the proportions
returning questionnaires were high."
The authors noted that other scores (personal care, lifting,
walking, standing, sex life, social life, and travelling) "nearly
all improved more in the patients treated with chiropractic, though
most of the differences were small compared with the differences
for pain."
The authors said they believe there is now more support for the
need for "fastidious" trials focusing on "specific components of
management and on their feasibility," and that the trial's results
show that "chiropractic has a valuable part to play in the
management of low back pain."
The study comes close on the heels of the recommendations of the
British back pain guidelines developed by the Clinical Standards
Advisory Group, published as Back Pain, and Epidemiology and Cost
of Back Pain.3 Those guidelines recommend that patients should not be put on waiting lists for hospital appointments, as that leads to increased time off work and disability. The British guidelines say
that back patients should be seen earlier in the community by
chiropractors, osteopaths, and physiotherapists skilled in
manipulation.
References
- Mead TW, Dyer S, Browne W, Frank AO. Randomised comparison of chiropractic and hospital outpatient management for low back pain: results from extended follow up. BMJ 1995;311:349-51.
- Meade TW, Dyer S, Browne W, Townsend J, Frank AO. Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ 1990;300:1431-7.
- Britain releases back pain guidelines, Dynamic Chiropractic, Feb. 13, 1995.
