There is a plethora of research that shows us that chiropractic care can be effective for, and is recommended in the clinical guidelines for, effective management of chronic low back pain. We also know that chiropractic is a care modality that is very individual. There is no one-pill panacea administered for every person under care. The chiropractor takes a careful history and checks for subluxations before adjusting these subluxations once found. What the body does when the nervous system is cared for is very much unique. There is plenty of data pointing to positive outcomes for back and neck pain, but a new study as taken a deep dive into the factors which may predict a baseline for response to chiropractic care even in the short term.
The study, titled “Predicting who response to spinal manipulative therapy using a short-frame methodology” took data from 238 participants who had undergone just one week of spinal manipulative therapy. Using this data, they performed a secondary analysis of a prior study in order to discover how eight variables might affect a person’s response to chiropractic care in the short term.
What are these variables? “Height, gender, neck or upper back pain, pain frequency in the past six months, the STarT Back Tool, patient expectations about medication and strengthening exercises and extension status [1].” (The STarT back tool is a system used for screening the severity of back pain.)
While Spinal Manipulative Therapy is also used by non-chiropractic manual therapists (such as physiotherapists and osteopaths under certain circumstances), it does feature heavily in chiropractic care. So too does the particular type of spinal manipulative therapy examined in the paper – high-velocity, low-amplitude thrusts applied to the vertebral column and commonly used by chiropractors to adjust subluxations.
This study is particularly interesting because chiropractic research often features findings after a single adjustment, or after longer time periods. Hence, if we have some indication as to any variances in response baselines, it may help us understand further studies. There have been difficulties in past studies trying to establish such a baseline [2].
THE STUDY IN QUESTION:
The original study involved participants aged between 18 and 60, who had low back and an Oswestry disability score of at least 20%. Exclusion criteria was applied to make sure that there were no extenuating factors that could influence the data. Each participant filled out personal demographic forms before being examined by clinicians at baseline and then after two sessions of spinal manipulative therapy within the space of one week.
Muscle activation and lumbar spine stiffness was measured at the baseline and at the one week mark, along with a number of other evaluations (the full study can be access at the address below [1]).
While the study includes a lot of statistical analysis, the key takeaways include the following:
- The researchers started with 20 difference history and demographic variables, 6 patient reported outcomes, 22 physical measures and 28 instrument measures.
- Of these variables, the most significant factors impacting on clinical outcomes after one week of care were; height, gender, neck or upper back pain, pain frequency, STarT back tool results, patient expectations about medication and strengthening exercises, and extension status.
- The results suggested that “it is possible to predict SMT response in a specific group of patients of with 91.2% accuracy in non-responder and 57.4% in responder after only two applications of standardized SMT over a one-week period.
- This is likely the first piece of research to do so to this degree of certainty.
- Previous research showed beliefs about illness and rehabilitation make a significant contribution to outcomes. This study affirmed this finding.
The authors remarked that “The 8 variable model presented here was able to predict SMT response with a sensitivity of 72.2% a specificity of 84.2%, and an overall classification accuracy of 81.5%. Given these results, and that 7 model variables can be collected prior to clinician engagement, future validation of the model is warranted.”
Further research is required to apply this model and further validate or explain its effectiveness in clinical settings. Additionally, the mechanisms behind these variables remain unexplained, especially the psychological or biochemical factors affecting the way patient expectations impact outcomes. But it is another step on the way to understanding the puzzle.
The full report can be found at the reference below.
REFERENCES:
- Hadizadeh, M., Kawchuck, G.N., Prasad, N., and Fritz, J., (2020). Predicting who responds to spinal manipulative therapy using a short-time frame methodology: results from a 238-participant study. PLoS One. doi: 1371/journal.pone.0242831
- Underwood MR, Morton V, Farrin A. Do baseline characteristics predict response to treatment for low back pain? Secondary analysis of the UK BEAM dataset [ISRCTN32683578]. Rheumatology. 2007;46: 1297–1302. [PubMed] [Google Scholar][Ref list]
