This study proposes to compare two innovative treatment approaches for LBP, both of which
focus on delivering individualized care through evidence-based, clinical care pathways.
The primary aim of the project is to determine the relative clinical efficacy of 1)
chiropractic care and 2) multidisciplinary, integrative care in 200 patients with sub-acute
or chronic LBP, in both the short-term (after 12 weeks) and long-term (after 52 weeks). The
primary outcome measure in this study is patient-rated back pain.
Chiropractic care will include therapies within the professional scope of practice.
Integrative, multidisciplinary care will include chiropractic, massage therapy, traditional
Chinese medicine (including acupuncture), medication, cognitive behavioral therapy,
exercise, and patient education.
Secondary aims are to assess between group differences in frequency of symptoms, disability,
fear avoidance behavior, self efficacy, general health, improvement, patient satisfaction,
work loss, medication use, lumbar dynamic motion, and torso muscle endurance. Patients' and
providers' perceptions of treatment will be described using qualitative methods and
cost-effectiveness and cost utility will be assessed in the short- and long-term.
This innovative study is an exciting collaboration between an experienced and established
team of chiropractic, conventional, and CAM professionals dedicated to advancing the care of
pervasive and costly LBP conditions. This trial will provide new and important information
for all health care providers and LBP patients, informing decision making and improving care
- Mechanical LBP classified as 1, 2, 3, or 4 using Quebec Task Force (QTF)
classification.70 (This includes back pain, stiffness or tenderness with or without
musculoskeletal and neurological signs).
- LBP localized to posterior aspect of body, below the costal margin and above the
inferior gluteal folds.
- Pain level > 3 on 0 to 10 scale
- Current LBP episode > 6 weeks duration
- 18 years of age and older
- Stable prescription medication plan (No changes in prescription medications that
affect musculoskeletal pain in the previous month.)
- Ongoing treatment for LBP by other non-study providers
- Progressive neurological deficits or cauda equina syndrome
- QTF classifications 5 (spinal instability or fracture) and 11 (other diagnoses
including visceral diseases, compression fractures, metastases). These are serious
conditions not amenable to the conservative treatments proposed.
- QTF 7 (Spinal stenosis syndrome characterized by pain and/or paresthesias in one or
both legs aggravated by walking).
- Uncontrolled hypertension or metabolic disease
- Blood clotting disorders
- Severe osteoporosis
- Inflammatory or destructive tissue changes of the spine
- Patients with surgical lumbar spine fusion or patients with multiple incidents of
lumbar surgery. This is a subgroup of LBP patients which generally have a poorer
- Pregnant or nursing women