Date ArticleType

Chiropractors and Acute Lower Back Pain, a Five-year Prospective Cohort Study

A standardized protocol of chiropractic lumbar spinal manipulative therapy (CSMT) and flexibility exercise instruction administered by community-based chiropractors to a specific cohort of patients with acute lower back pain (ALBP) is a feasible component of a primary care spine treatment pathway.

Patient access to current best evidence primary care treatment for acute lower back remains highly problematic. Treatment pathway models have the potential to improve patient access to care, provide seamless transitions from one form of treatment to another, optimize clinical outcomes, improve cost-effectiveness and reduce progression to chronic illness /pain. A standardized protocol of hospital-based outpatient clinic CSMT as a component of care for patients with ALBP has been previously validated.
To determine the feasibility and patient satisfaction of a community-based standardized chiropractic treatment protocol as a component of a primary care spine treatment pathway in the treatment of patients with ALBP, a feasibility prospective cohort study that included patients with ALBP without radiculopathy of less than 24 weeks was conducted.
Over the five-year duration of the study, 368/380 (97%) of eligible patients and 21/26 (81%) of community-based chiropractors agreed to participate. Seventeen of 21 chiropractors (81%) consistently administered treatment within the boundaries of the standardized research study protocol. VAS and ODI scores improved significantly in 320/368 (87%) patients. The average wait time for access to treatment was 7.4 days. Eighty-two percent of patients reported high satisfaction scores. The rate of required additional diagnostic imaging was 3%. Rates of discharge from the hospital spine program outpatient clinic with no requested follow-up by six months was 86%.

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