Comparison of chiropractic and hospital outpatient management of low back pain: a feasibility study. Report of a working group

Abstract

This is the report of a feasibility study of a randomised controlled trial of chiropractic and hospital outpatient management for low back pain of mechanical origin. Preparations for the study included an approach to the General Medical Council for guidance about the intended collaboration between medically qualified and heterodox practitioners, detailed communication with local general practitioners, and the provision of a Medical Research Council (MRC) grant to cover payments to the chiropractors for work carried out in the course of the study. A total of 238 patients were considered, 197 of whom had initially presented to Northwick Park Hospital and the remaining 41 to the chiropractic clinic in Harrow. Only 6% of the patients presenting to the hospital refused to enter. The single most frequent reason for ineligibility in the hospital patients was freedom from pain at the time of the first hospital visit (23%). A variety of medical contraindications accounted for the exclusion of a further 24% of hospital patients. Patients presenting to the chiropractic group tended to have had shorter current episodes of back pain but to have had more NHS treatment in the past than those presenting to hospital. The commonest reason for exclusion among those presenting to the chiropractic clinic was refusal to enter (34%). Only 5% of the chiropractic patients were ineligible for medical reasons. Overall, 16% of those presenting to hospital and 44% of those presenting to the chiropractors were eligible and willing to enter the randomised treatment phase of the study. Of the 50 patients who entered the treatment phase, all but seven completed treatment and the six weekly self-completed assessments of progress. Patients whose current episodes had lasted less than a month progressed significantly more rapidly than those with longer current episodes. It is likely that sufficient numbers of patients with low back pain are prepared to take part in a formal randomized controlled trial. The organization and working methods for such a trial appear to be feasible. A full scale multicentre trial should aim to include about 2000 patients.