OVERALL IMPROVEMENT AND PATIENT SATISFACTION WITH CHIROPRACTIC CARE FOR BACK PAIN IS NOT ACCOUNTED FOR BY ‘THE USUAL’ OUTCOME MEASURES

Abstract

Background: Back pain is often characterised by recurrent episodes and low patient satisfaction with care and there is little evidence about what constitutes improvement as perceived by the sufferer. Care by chiropractors has been associated with high patient satisfaction, often apparently out of proportion to other outcomes (1), but little is known about what actually contributes to this.

Methods and results: Baseline questionnaires were completed by 965 patients with low back pain of all durations at the start of chiropractic treatment, with blinded follow-up at 6 weeks. Patients were asked about the commonly used functional and affective outcomes of: pain intensity, normal activity, work, affect on lifestyle, ability to control pain, anxiety and perceived depression. The contribution of change in these scores to overall improvement and satisfaction with care was evaluated by stepwise multiple regression. Pain intensity, work and ability to control pain predicted 27% of the variance in overall improvement, leaving 73% unexplained by any of the variables. Overall improvement predicted 57% of satisfaction leaving 43% unexplained. A 2-stage block regression to find out what factors other than overall improvement predicted satisfaction revealed that ability to carry out normal activities alone predicted only an additional 0.5% of this. (All relationships were significant at the 5% level or below.)

Conclusions: Some of the overall improvement following chiropractic treatment for back pain was significantly predicted by functional outcomes alone. Very few items other than overall improvement predicted satisfaction. There is a need to consider what other factors constitute improvement and lead to satisfaction with care for low back pain.