TITLE

Prediction of pain outcomes in a randomized controlled trial of dose-response of spinal manipulation for the care of chronic low back pain

AUTHOR(S)
Vavrek, Darcy; Haas, Mitchell; Blazej Neradilek, Moni; Polissar, Nayak
PUB. DATE
August 2015
SOURCE
BMC Musculoskeletal Disorders;Aug2015, Vol. 16 Issue 1, p1
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: No previous studies have created and validated prediction models for outcomes in patients receiving spinal manipulation for care of chronic low back pain (cLBP). We therefore conducted a secondary analysis alongside a dose-response, randomized controlled trial of spinal manipulation. Methods: We investigated dose, pain and disability, sociodemographics, general health, psychosocial measures, and objective exam findings as potential predictors of pain outcomes utilizing 400 participants from a randomized controlled trial. Participants received 18 sessions of treatment over 6-weeks and were followed for a year. Spinal manipulation was performed by a chiropractor at 0, 6, 12, or 18 visits (dose), with a light-massage control at all remaining visits. Pain intensity was evaluated with the modified von Korff pain scale (0-100). Predictor variables evaluated came from several domains: condition-specific pain and disability, sociodemographics, general health status, psychosocial, and objective physical measures. Three-quarters of cases (training-set) were used to develop 4 longitudinal models with forward selection to predict individual "responders" (≥50 % improvement from baseline) and future pain intensity using either pretreatment characteristics or post-treatment variables collected shortly after completion of care. The internal validity of the predictor models were then evaluated on the remaining 25 % of cases (test-set) using area under the receiver operating curve (AUC), R², and root mean squared error (RMSE). Results: The pretreatment responder model performed no better than chance in identifying participants who became responders (AUC = 0.479). Similarly, the pretreatment pain intensity model predicted future pain intensity poorly with low proportion of variance explained (R² = .065). The post-treatment predictor models performed better with AUC = 0.665 for the responder model and R² = 0.261 for the future pain model. Post-treatment pain alone actually predicted future pain better than the full post-treatment predictor model (R² = 0.350). The prediction errors (RMSE) were large (19.4 and 17.5 for the pre- and post-treatment predictor models, respectively). Conclusions: Internal validation of prediction models showed that participant characteristics preceding the start of care were poor predictors of at least 50 % improvement and the individual's future pain intensity. Pain collected shortly after completion of 6 weeks of study intervention predicted future pain the best.
ACCESSION #
109221945

 

Related Articles

  • Chiropractic for low back pain. Ernst, E.; Assendelft, W.J.J. // BMJ: British Medical Journal (International Edition);07/18/98, Vol. 317 Issue 7152, p160 

    Editorial. Comments on the safety and effectiveness of chiropractic as a treatment for low back pain. In-depth look at chiropractic; Details on controlled trials of spinal manipulation; Problems with cervical manipulations; Questioning whether chiropractic saves money in the healthcare system.

  • Adverse effects of spinal manipulation. Barrett, Alisa J.; Breen, Alan C. // Journal of the Royal Society of Medicine;May2000, Vol. 93 Issue 5, p258 

    Guidelines on acute back pain recommend spinal manipulation, but some commentators express concern that the adverse effects are under-reported. Eleven chiropractors distributed questionnaires to 108 consecutive new patients aged >18 years, enquiring about adverse effects one hour, one day and...

  • Chiropractic spinal manipulation for back pain. Ernst, E. // British Journal of Sports Medicine;Jun2003, Vol. 37 Issue 3, p195 

    Focuses on the uncertainty of the effectiveness of chiropractic spinal manipulation for back pain. Skills of sports medicine clinicians in joint mobilization and manipulation; Lack of identifiable risk factors.

  • Protruded Lumbar Discs Respond Well to Manipulation. Murphy, Dan // American Chiropractor;Mar2009, Vol. 31 Issue 3, p16 

    The article presents key points from Doctor Dan Murphy regarding a study on the treatment of lumbar intervertebral disc protrusions by manipulation. It states that low back pain is often related to problems with the intervertebral disc and accounts for one-third of all orthopedic outpatient...

  • To Stabilize Lumbar Fixations. Danchik, John // American Chiropractor;Apr2010, Vol. 32 Issue 4, p36 

    The article presents a case study of a 56-year-old woman with history of lower back pain and disability. She underwent chiropractic evaluation and diagnosed with chronic lumbopelvic fixations due to the anatomical discrepancy in leg length. She was recommended to undergo spinal adjustments and...

  • Identifying Patients with Low Back Pain Who Are Likely To Benefit from Spinal Manipulation. Childs, J. D.; Fritz, J. M.; Flynn, T. W.; Irrgang, J. J.; Johnson, K. K.; Majkowski, G. R.; Delitto, A. // Annals of Internal Medicine;12/21/2004, Vol. 141 Issue 12, pI39 

    The article presents information on a study about clinical predictions rule to identify patients with low back pain most likely to benefit from spinal manipulation in the question and answer form. Low back pain is a common problem. Traditional treatments that are helpful for some patients with...

  • Low-Back Pain and Related Leg Complaints.  // ACA News (American Chiropractic Association);Jun2009, Vol. 5 Issue 6, p27 

    The article presents a study regarding the effectiveness of chiropractic spinal manipulation as treatment for low-back pains and other related complaints. It states that the study aims to provide accurate interpretation of the literature in order to identify the effective treatment for low-back...

  • The Healthy Consumer: What the Research Shows.  // Mayo Clinic Guide to Self-Care;2005, p281 

    Discusses the findings of research about chiropractic treatment. Use of spinal manipulation to treat uncomplicated low back pain; Temporary pain relief; Effectiveness of chiropractic care in short-term treatment duration.

  • Chiropractic in the Media.  // ACA News (American Chiropractic Association);Dec2012, Vol. 8 Issue 12, p16 

    The article discusses 2012 media reports in which chiropractic was portrayed positively, including a tweet on the social networking web site Twitter by former professional football player Emmitt Smith, a story on chiropractic care for back pain which was featured on the webs site of the...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics