Comparative Effectiveness of Usual Care With or Without Chiropractic Care in Patients with Recurrent Musculoskeletal Back and Neck Pain
Vollmer, William M.
Deyo, Richard A.
Johnson, Eric S.
complementary and integrative medicine
chronic musculoskeletal pain
MetadataShow full item record
CitationElder, C., DeBar, L., Ritenbaugh, C. et al. J GEN INTERN MED (2018) 33: 1469. https://doi.org/10.1007/s11606-018-4539-y
Rights© Society of General Internal Medicine 2018
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at email@example.com.
AbstractChiropractic care is a popular alternative for back and neck pain, with efficacy comparable to usual care in randomized trials. However, the effectiveness of chiropractic care as delivered through conventional care settings remains largely unexplored. To evaluate the comparative effectiveness of usual care with or without chiropractic care for patients with chronic recurrent musculoskeletal back and neck pain. Prospective cohort study using propensity score-matched controls. Using retrospective electronic health record data, we developed a propensity score model predicting likelihood of chiropractic referral. Eligible patients with back or neck pain were then contacted upon referral for chiropractic care and enrolled in a prospective study. For each referred patient, two propensity score-matched non-referred patients were contacted and enrolled. We followed the participants prospectively for 6 months. Main outcomes included pain severity, interference, and symptom bothersomeness. Secondary outcomes included expenditures for pain-related health care. Both groups' (N = 70 referred, 139 non-referred) pain scores improved significantly over the first 3 months, with less change between months 3 and 6. No significant between-group difference was observed. (severity - 0.10 (95% CI - 0.30, 0.10), interference - 0.07 (- 0.31, 0.16), bothersomeness - 0.1 (- 0.39, 0.19)). After controlling for variances in baseline costs, total costs during the 6-month post-enrollment follow-up were significantly higher on average in the non-referred versus referred group ($1996 [SD = 3874] vs $1086 [SD = 1212], p = .034). Adjusting for differences in age, gender, and Charlson comorbidity index attenuated this finding, which was no longer statistically significant (p = .072). We found no statistically significant difference between the two groups in either patient-reported or economic outcomes. As clinical outcomes were similar, and the provision of chiropractic care did not increase costs, making chiropractic services available provided an additional viable option for patients who prefer this type of care, at no additional expense.
Note12 month embargo; published online: 25 June 2018
VersionFinal accepted manuscript
SponsorsNational Institutes of Health, Center for Complementary and Integrative Health [R01 AT005896]
- Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial.
- Authors: Goertz CM, Long CR, Vining RD, Pohlman KA, Walter J, Coulter I
- Issue date: 2018 May 18
- The feasibility of matching on a propensity score for acupuncture in a prospective cohort study of patients with chronic pain.
- Authors: Johnson ES, Dickerson JF, Vollmer WM, Rowley AM, Ritenbaugh C, Deyo RA, DeBar L
- Issue date: 2017 Mar 16
- Comparative effectiveness and economic evaluation of Chuna manual therapy for chronic neck pain: protocol for a multicenter randomized controlled trial.
- Authors: Do HJ, Shin JS, Lee J, Lee YJ, Kim MR, Cho JH, Kim KW, Ha IH
- Issue date: 2018 Nov 29
- First-contact care with a medical vs chiropractic provider after consultation with a swiss telemedicine provider: comparison of outcomes, patient satisfaction, and health care costs in spinal, hip, and shoulder pain patients.
- Authors: Houweling TA, Braga AV, Hausheer T, Vogelsang M, Peterson C, Humphreys BK
- Issue date: 2015 Sep
- Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain.
- Authors: Thomas KJ, MacPherson H, Ratcliffe J, Thorpe L, Brazier J, Campbell M, Fitter M, Roman M, Walters S, Nicholl JP
- Issue date: 2005 Aug