The Nordic back pain subpopulation program: the long-term outcome pattern in patients with low back pain treated by chiropractors in Sweden

Abstract

Objectives: (1) To describe the low back pain (LBP) pattern at baseline; (2) to describe the long-term outcome pattern; (3) to investigate the presence of distinct subgroups in relation to outcome; (4) to establish whether short-term outcome is a predictor of long-term outcome.

Methods: A 3- to 6- and 12- to 18-month, multicenter practice-based, prospective descriptive study was performed in private chiropractic practices in Sweden. Fifty-eight of 64 previously compliant chiropractors each recruited a maximum of 30 consecutive patients with LBP. Complete baseline clinical information was provided on 1054 patients, of which 93% were interviewed approximately 3 months later, and 57% responded to a questionnaire at approximately 12 months. Chiropractic treatment was decided by the treating chiropractor. Twelve descriptive subgroups were created based on (1) duration of LBP at baseline, (2) duration of LBP in the past year, and (3) LBP pattern in the past year. The predictive value was tested for outcome status at the fourth visit. Information on self-reported LBP status and improvement over the past months were collected.

Results: Patients were spread in a U-shaped fashion from benign to severe with the 2 extreme groups being most prevalent. About half the participants reported "no LBP in the past week" at 3 months and somewhat fewer at 12 months. Almost 75% claimed to be definitely better at 3 months, and approximately 50% at 12 months. Specific predictive subgroups can be identified, mainly in relation to the past-year history of LBP. Improvement at the fourth visit is a predictor of long-term outcome.

Conclusion: Knowledge of specific subgroups may improve the quality of care and the selection of homogeneous study populations in clinical trials.