Original article
The Nordic Back Pain Subpopulation Program: A 1-Year Prospective Multicenter Study of Outcomes of Persistent Low-Back Pain in Chiropractic Patients

https://doi.org/10.1016/j.jmpt.2005.01.010Get rights and content

Objectives

The aims of the study are to describe the low-back pain and disability status at baseline, the fourth visit, and at 3 and 12 months in Norwegian patients treated by chiropractors for persistent low back pain (LBP) and to describe movements between various subgroups over time.

Design

Prospective uncontrolled multicenter study.

Methods

Self-reported pain was measured with a 0-10 box scale and disability with the revised Oswestry LBP questionnaire. The main outcome measures were mean pain or disability values and numbers of LBP-free patients. LBP status was assessed through patient questionnaires at baseline, the fourth visit, and after 3 and 12 months.

Study Subjects and Setting

Of 205 invited chiropractors, 115 Norwegian chiropractors were each willing to recruit 10 consecutive patients who had LBP for at least 2 weeks at the time of consultation and a minimum of 30 days altogether within the preceding year. The numbers of participants were 875 (baseline), 799 (fourth visit), 598 (3 months), and 512 (12 months).

Results

Considerable improvement was noted between baseline and the fourth visit both for mean values and in numbers of LBP-free patients. There was virtually no further mean improvement up to the third month, whereas the number of LBP-free individuals doubled. At 12 months, no additional improvement was noted, and 80% reported that they had experienced recurrent problems. Less than 1% reported considerable worsening. Severity of symptoms at baseline determined the subsequent outcome, mild symptoms tending to worsen, and severe symptoms tending to improve.

Conclusion

The outcome pattern is similar to that found in other clinical studies. Treatment outcome should be measured early with follow-up at 3 rather than at 12 months, because patients will improve or recover quickly but may experience recurring problems. Numbers “cured” appear to be a feasible outcome variable in this type of study population.

Section snippets

Methods

The materials and methods have been described in detail elsewhere,4 and a summary is provided below. A research group consisting of 7 chiropractors practicing in Norway designed the study, invited all their colleagues to participate in the study, provided written and verbal instruction, and maintained contact with the participants throughout the study. One team member (A.G.) was responsible for the logistics of the data collection. The first author supervised the entire process.

In the year

Study Sample

Baseline information was collected from 951 patients. Of these, 76 were removed because of uncertainties regarding the inclusion criteria, leaving 875 subjects for the data analysis. At the fourth visit, valid information was obtained from 799 patients, and from 598 and 512 patients after 3 and 12 months, respectively.

A detailed description of the study sample is provided elsewhere,4 necessitating only a summary of the typical patient in the present report. There were almost equal numbers of

Discussion

According to this study, most improvement occurs early in the course of treatment, and a large number of patients have relapses during the coming year. This is a prognostic pattern resembling that of other types of LBP patients receiving other types of therapy,1, 2, 9, 10, 11, 12, 13, 14, 15, 16 including osteopathic spinal manipulative therapy.17

If the outcome were mainly explained by the natural course, improvement would be expected to occur in relation to the duration from the onset of

Conclusion

From a research perspective, the following aspects are important. Treatment outcome should be measured early in the course of treatment and the final follow-up somewhere not too distant in time, because LBP is a disorder that likely reacts quickly to treatment but is of cyclic/recurring nature.

An individual-based outcome, such as numbers of patients who become “LBP-free,” should be used in clinical studies to allow for the number-needed-to-treat calculation. Mean measurements are not

Acknowledgments

The authors thank Alan Jordan, DC, PhD, for his editorial assistance.

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    Sources of support: funding was provided by the Research Council of Norway and the Swedish Chiropractic Association.

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    Copyright © 2005 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.