Synopsis: Evaluation of 4 different back pain interventions showed no differential benefit between them.
Source: Hsieh CY, et al. Spine. 2002;27:1142-1148.
This randomized, assessor-blinded clinical trial was designed to investigate the effectiveness of 3 manual treatment regimens (joint manipulation, myofascial therapy, or a combination of these 2) vs. a back education program. Two hundred patients were assigned to 1 of the 4 groups, with assessments at baseline, every 3 weeks, and at 6 months after the completion of therapy. The primary outcome measures used visual analog scales and Roland-Morris activity scales.
Comment by Brian R. Apatoff, MD
All 4 groups showed equal improvement in pain and activity scores after 3 weeks of treatment and had no further benefit at the 6-month follow-up assessment. There was no significant difference between outcomes using chiropractic treatments as compared to the back education school. Given that back pain is such a large issue in neurology, costing hundreds of millions for the health economy, it is hoped that such well-designed studies will provide evidence-based medicine to guide rational health care and eliminate unhelpful chiropractic methods.
Dr. Apatoff is Associate Professor of Neurology, New York Presbyterian Hospital-Cornell Campus, New York, NY.