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Posted by S. Delerme
In Reply to: The McKenzie 7 Step Method posted by Josh Steinberg (MD), Syracuse
A comparison of physical therapy, chiropractic manipulation, and provision of
an educational booklet for the treatment of patients with low back pain.
Cherkin DC, Deyo RA, Battie M, Street J, Barlow W
Department of Health Services, University of Washington, Seattle 98101, USA.
BACKGROUND AND METHODS: There are few data on the relative effectiveness and
costs of treatments for low back pain. We randomly assigned 321 adults with
low back pain that persisted for seven days after a primary care visit to the
McKenzie method of physical therapy, chiropractic manipulation, or a minimal
intervention (provision of an educational booklet). Patients with sciatica
were excluded. Physical therapy or chiropractic manipulation was provided for
one month (the number of visits was determined by the practitioner but was
limited to a maximum of nine); patients were followed for a total of two
years. The bothersomeness of symptoms was measured on an 11-point scale, and
the level of dysfunction was measured on the 24-point Roland Disability
Scale. RESULTS: After adjustment for base-line differences, the chiropractic
group had less severe symptoms than the booklet group at four weeks (P=0.02),
and there was a trend toward less severe symptoms in the physical therapy
group (P=0.06). However, these differences were small and not significant
after transformations of the data to adjust for their non-normal
distribution. Differences in the extent of dysfunction among the groups were
small and approached significance only at one year, with greater dysfunction
in the booklet group than in the other two groups (P=0.05). For all outcomes,
there were no significant differences between the physical-therapy and
chiropractic groups and no significant differences among the groups in the
numbers of days of reduced activity or missed work or in recurrences of back
pain. About 75 percent of the subjects in the therapy groups rated their care
as very good or excellent, as compared with about 30 percent of the subjects
in the booklet group (P<0.001). Over a two-year period, the mean costs of
care were $437 for the physical-therapy group, $429 for the chiropractic
group, and $153 for the booklet group. CONCLUSIONS: For patients with low
back pain, the McKenzie method of physical therapy and chiropractic
manipulation had similar effects and costs, and patients receiving these
treatments had only marginally better outcomes than those receiving the
minimal intervention of an educational booklet. Whether the limited benefits
of these treatments are worth the additional costs is open to question.
