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Is Chiropractic Used Appropriately for Low Back Pain?

A recent practice guideline, developed by the U.S. Agency for Health Care Policy and Research, recommends spinal manipulation for some patients with uncomplicated acute low back pain. To assess whether spinal manipulation is being initiated appropriately, researchers reviewed records of 10 patients with low back pain from each of 131 randomly selected chiropractic offices in North America.

"Appropriateness" -- defined as expected benefits exceeding risks -- was judged by a panel of experts, including allopathic and osteopathic generalists and specialists, surgeons, and chiropractors, with the aid of a systematic literature review.

A total of 859 patients receiving spinal manipulation had records detailed enough to evaluate. Of these, indications were judged appropriate in 46 percent, uncertain in 25 percent, and inappropriate in 29 percent. The highest rate of inappropriateness (56 percent) was in patients with chronic (rather than subacute or acute) low back pain. Of 148 patients not receiving spinal manipulation, 62 percent were classified as having uncertain or inappropriate indications.

Comment: Although chiropractic care is often initiated appropriately, more than half the patients who received spinal manipulation were treated for indications judged to be inappropriate or uncertain. Furthermore, research is clearly needed to determine the relationship between appropriateness and treatment effectiveness.

— R Saitz

Published in Journal Watch General Medicine July 10, 1998

Citation(s):

Shekelle PG et al. Congruence between decisions to initiate chiropractic spinal manipulation for low back pain and appropriateness criteria in North America. Ann Intern Med 1998 Jul 1 129 9-17.

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