Hertzman-Miller R, Morgenstern H, Hurwitz E, et al. “Comparing the Satisfaction of Low Back Pain Patients Randomized to Receive Medical or Chiropractic Care: Results From the UCLA Low Back Pain Study.” American Journal of Public Health 2002; 92: 1628-1633.
Approximately one third as many back pain patients seek chiropractic care compared to those who seek medical care. The physician community is taking note of the chiropractors’ ability to treat lower back pain and their high patient satisfaction. In earlier randomized clinical trials, investigators found spinal manipulation to have similar or better rates of patient satisfaction when compared to medical approaches like physical therapy, McKenzie method and standard medical therapy. This study examined the differences in satisfaction between patients assigned to either medical care or chiropractic care in a managed care organization. In this randomized trial, the chiropractic patients were more satisfied with their back care after 4 weeks of treatment. One possible explanation is that the self-care advice and explanation of treatment had strong effects on patient satisfaction. They also point out that chiropractors might give more detailed physical examinations than do medical providers. They conclude that providers in managed care organizations might be able to increase the satisfaction of their low back pain patients by communicating advice and information to patients about their condition and treatment.
Hoving J, Koes B, De Vet H, Van Der Windt D, Assendelft W, Van Mameren H, Deville W, Pool J, Scholten R, Bouter L . “Manual Therapy, Physical Therapy or Continued Care by a General Practitioner for Patients with Neck Pain.” Annals of Internal Medicine 2002; 136: 713-7220.
In a randomized, controlled trial, researchers compared the effectiveness of manual therapy, physical therapy (PT) and continued care by a general practitioner (GP) in patients with nonspecific neck pain. The success rate at seven weeks was twice as high for the manual therapy group (68.3 percent) as for the continued care group (general practitioner). Manual therapy scored better than physical therapy on all outcome measures. Additionally, patients receiving manual therapy had fewer absences from work than patients receiving physical therapy or continued care. The magnitude of the differences between manual therapy and the other treatments (PT or GP) was most pronounced for perceived recovery. Because perceived recovery combines other outcomes, such as pain, disability and patient satisfaction, it may be the most responsive outcome measure.
Hawk C, Long CR, Boulanger KT. “Patient Satisfaction with the Chiropractic Clinical Encounter: Report from a Practice-Based Research Program.” Journal of the Neuromusculoskeletal System 2001; 9(4): 109-117.
When 2,987 patients from a variety of rural and urban locations in the United States and Canada completed a data collection survey, 85 percent stated, “Their chiropractor always listened carefully.” 85.3 percent stated, “The chiropractor explained things understandably.” 88.2 percent stated, “The chiropractor showed respect for what they had to say.” Overall, the majority of patients were highly satisfied with their care.
Gemmell HA, Hayes BM. “Patient Satisfaction with Chiropractic Physicians in an Independent Physicians Association.” Journal of Manipulative and Physiological Therapeutics 2001; 24(9): 556-559.
In this study, 150 chiropractic patients were surveyed. Chiropractic care received “excellent” remarks by percentage, in the following categories: Time to Get an Appointment – 84.9 percent; Convenience of Office - 57.7 percent; Access to Office by Phone - 77.3 percent; Length of Wait - 75.7 percent; Time Spent with Provider - 74.3 percent; Explanation of Treatment - 72.8 percent; Skill of Provider - 83.3 percent; Personal Manner of the Chiropractor - 92.4 percent. The “Overall Visit” category was given the “excellent” response by 83.3 percent of those surveyed.
Nyiendo J, Haas M, Goodwin P. “Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study.” Journal of Manipulative and Physiological Therapeutics 2000; 23: 239-45.
Patients with chronic (>6 weeks), recurrent lower back pain were treated by either a private chiropractor or a family medicine clinic. After one month of treatment, chiropractic patients averaged higher improvement across all outcome measurements. The differences between provider groups were most marked for the question involving satisfaction with overall care (chiropractic-90%; medical–52%). Chiropractic patients also reported greater improvement and in pain severity and functional disability. This study concluded that chiropractic patients expressed greater satisfaction regarding information and treatment provided.
Burton AK, Tillotson KM, Cleary J. “Single-blind randomized controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation.” European Spine Journal 2000; 9: 202-207.
Forty patients with confirmed sciatica were treated with either osteopathic manipulation treatment or chemonucleolysis. The pain endured by the patient was measured at 2 weeks, 6 weeks and one year. After a year patients from both groups were very similar in recovery. However, at 2 and 6 weeks those receiving manipulations reported greater improvement.
Giles L, Muller R. “Chronic Spinal Pain Syndrome: A Clinical Pilot Trial Comparing Acupuncture, a Non-Steroidal Anti-Inflammatory Drug and Spinal Manipulation.” Journal of Manipulative and Physiological Therapeutics 1999; 22: 376-81.
Patients referred to Townsville General Hospital outpatient Spinal Pain Unit in Australia for evaluation and treatment of chronic (>13 weeks) spinal pain were randomized to acupuncture, medication or spinal manipulation. After 30 days of treatment only the manipulation subgroup showed significant reduction in pain intensity. Remarkably, the manipulation group displayed uniform, significant, substantial improvements across all outcome measurements while in the two other intervention groups not a single significant improvement could be found.
Davis TP, Hulbert JR, Kassem KM, Meyer JJ. “Comparative Efficacy of Conservative Medical and Chiropractic Treatments for Carpal Tunnel Syndrome: A Randomized Clinical Trial” Journal of Manipulative and Physiological Therapeutics 1998; 21(5): 317-326.
This study sought to compare the effects of chiropractic care and conventional medical care for managing carpal tunnel syndrome. 91 patients with confirmed symptoms of carpal tunnel syndrome were divided into two groups. One group received decreasing amounts of ibuprofen over three weeks. The other group received manipulation of bony joints and soft tissues of the upper extremities and spine. The patients’ improvement was monitored through self-reports and analyses of the vibrometric sensibility of the hands. There was improvement in comfort, finger sensation and nerve conduction in both groups. For right hands affected by carpal tunnel the group who received medical care improved by 1.37 decibels according to the vibrometric tests. Those receiving chiropractic care improved by 3.05 decibels.
Nilsson N, Christensen HW, Harvigsen J. “The Effect of Spinal Manipulation in the Treatment of Cervicogenic Headache.” Journal of Manipulative and Physiological Therapeutics 1997; 20(5): 326-330.
Of 53 individuals who were diagnosed with cervicogenic headaches, 28 individuals in the group received high-speed, low-amplitude spinal manipulation in the cervical spine two times a week for three weeks. The rest of the group received low-level laser to the upper cervical region and deep-friction massage in the lower cervical/upper thoracic region two times a week for three weeks. For those who received spinal manipulation treatment, the amount of headache hours per day decreased 69 percent; for those receiving laser treatment, the decrease was only 37 percent. Intensity of headache decreased 36 percent for those receiving manipulations and 17 percent for those receiving laser treatment. The use of pain relievers went down 36 percent for those receiving manipulations and was unchanged for those receiving laser treatment.
Meade TW, Dyer S, et al. “Randomized Comparison of Chiropractic and Hospital Outpatient Management for Low Back Pain: Results from Extended Follow Up.” British Medical Journal Aug 1995, Vol. 311.
741 patients were randomly allocated to either chiropractic or hospital outpatient management. A 1990 study by these researchers reported greater improvement in patients with low back pain treated by chiropractors. This paper looks at data after a three-year follow-up. According to total Oswestry scores, improvement in chiropractic patients was 29 percent more than those treated by hospitals. The beneficial effect of chiropractic on pain was particularly clear. Other scores (personal care, lifting, walking, standing, sex life, social life and traveling) also nearly all improved more in the patients treated with chiropractic care. The substantial benefit of chiropractic on intensity of pain is evident early on and then persists. A higher proportions of patients considered chiropractic care helpful in comparison with hospital treatments. The results show that chiropractic has a valuable part to play in the management of low back pain.
Boline PD, Kassem K, Bronfort G, Nelson C, Anderson A. “Spinal Manipulation vs. Amitriptyline for the Treatment of Chronic Tension-Type Headaches: A Randomized Clinical Trial.” Journal of Manipulative and Physiological Therapeutics 1995; 18(3): 148-154.
This study compared the effects of spinal manipulation and pharmaceutical treatments for chronic tension headaches. Four weeks following the cessation of treatment, the pharmaceutical group demonstrated no improvement from the baseline. In the spinal manipulation group, headache intensity dropped 32 percent; frequency dropped 42 percent; and there was an overall improvement of 16 percent in functional health status.
Carey TS, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker DR. “The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project.” New England Journal of Medicine 1995; 333(14): 913-917.
This study sought to compare patients’ recovery and satisfaction for those with acute low back pain receiving care from the following six groups: Urban Primary Care Physicians; Rural Primary Care Physicians; Urban Doctors of Chiropractic (DCs); Rural DCs; Orthopedic Surgeons; and Primary Care Providers at a Group Model HMO. After six months, functional recoveries, return to work and complete back pain recoveries were similar for all groups. Satisfaction with care was highest for those visiting DCs.
Manga, Pran; Angus, Doug; Papadopoulos, Costa; Swan, William. "The Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain." Richmond Hill, Ontario: Kenilworth Publishing, 1993.
A major study to assess the most appropriate use of available health care resources was reported in 1993 by the Ontario Ministry of Health. The report overwhelmingly supported the efficacy, safety, scientific validity and cost-effectiveness of chiropractic for low back pain. “There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic complications for low back pain patients. The literature suggests that chiropractic manipulation is safer than medical management of low back pain. There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost effective than medical management. The evidence includes studies showing lower chiropractic costs for the same diagnosis and episodic need for care. There is good empirical evidence that patients are very satisfied with chiropractic management of low back pain and considerably less satisfied with physician management. Patient satisfaction is an important health outcome indicator and adds further weight to the clinical and health economic results favoring chiropractic management of low back pain.”
Sawyer CE, Kassak K. “Patient Satisfaction With Chiropractic Care” Journal of Manipulative and Physiological Therapeutics 1993; 16(1): 25-32.
341 new and returning chiropractic patients in Minnesota and Wisconsin completed a patient satisfaction questionnaire. Overall, patients demonstrated a high level of satisfaction with their doctors of chiropractic. 84% of respondents felt their chiropractic care was “just about perfect.” 97% agreed or strongly agreed that they would “recommend this doctor to a friend or relative.”
Meade TW, Dyer S, Browne W, Townsend J, Frank AO. “Low Back Pain of Mechanical Origin: Randomized Comparison of Chiropractic and Hospital Outpatient Treatment.” British Medical Journal 1990; 300(2): 1431-1437.
741 patients, who had neither been treated in the past month nor had contraindications to spinal manipulation, were treated either by doctors of chiropractic or with conventional hospital outpatient treatment for management of low back pain. Using the Oswestry scale, which quantifies pain, patients reported back on their improvement at six weeks, six months, one year and two years. At two years, chiropractic care resulted in a 7 percent benefit over hospital care.
Cherkin, D., MacCornack, F. “Chiropractic in the Mainstream: Patient Evaluations of Care from Family Physicians and Chiropractors.” Western Journal of Medicine March 1989.
This survey show that patients of chiropractors were three times as likely as patients of family physicians to respond that they were satisfied with the care they received for low back pain. Chiropractic patients were also more likely to have been satisfied with the amount of information they were given and to believe their doctors were concerned about them. This study was conducted at the Group Health Cooperative of Puget Sound, a 40-year-old staff-model Health Maintenance Organization (HMO) in western Washington State with 32,000 enrollees. The percentage of chiropractic patients who were “very satisfied” with the care they received for low back pain was triple that for patients of family physicians (66 percent versus 22 percent). Patients of family physicians were significantly less likely to report having received a graphic description of the causes of low back pain or instruction on exercise, posture and lifting techniques.