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Chiropractic Research Review

Patient Satisfaction May Predict Short-Term Clinical Outcomes of Back Pain Care

Low back pain is the most common reason for the initiation of chiropractic care. Studies have shown that chiropractic patients with low back pain have reported greater satisfaction with their care compared to patients seeing a medical doctor for low back pain.

Whether patient satisfaction is an accurate predictor of long-term clinical improvement, such as verifiable changes in pain in disability, is an issue that has yet to be investigated thoroughly.

In this randomized, controlled trial, 610 adult patients with low back pain presenting to a managed care facility were assigned to receive either chiropractic care (with and without physical modalities) or medical care (with and without physical therapy) for 18 months. At four weeks following randomization, participant satisfaction with care was evaluated on a 40-point scale. Questionnaires related to severity of low back pain, improvement, frequency of back pain, and related disability were administered at six weeks, six months, 12 months and 18 months postrandomization.

Results: Greater satisfaction with care increased the odds of remission from clinically meaningful pain and disability at six weeks, but not at six months, 12 months, or 18 months. Similarly, greater satisfaction with care was positively associated with the perception of improvement at six weeks, but this notion did not persist during any of the subsequent assessments. "Nevertheless," the authors reported, "highly satisfied patients were more likely than less satisfied patients to perceive their improvement as a lot better throughout the 18-month follow-up period."

Conclusion: "There appears to be a small short-term benefit of satisfaction with care on clinical outcomes among low back pain patients enrolled in a clinical trial of medical and chiropractic care in managed care," the scientists wrote. They added, "These findings, coupled with others from the UCLA Low Back Pain Study, suggest that clinical improvement may be predictive of patient satisfaction, and satisfaction may be predictive of clinical improvement, at least in the short term, although subsequent investigations should attempt to confirm such findings."

Hurwitz EL, Morgenstern H, Yu F. Satisfaction as a predictor of clinical outcomes among chiropractic and medical patients enrolled in the UCLA Low Back Pain Study. Spine Oct. 1, 2005;30(19):2121-2128.

Chiropractic Research Review

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