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Chiropractic Research Review

Physical Modalities - No Long-Term Benefits?

Chiropractors often use physical modalities such as ultrasound, heat therapy, and electrical muscle stimulation (EMS) concurrently with spinal manipulation to treat low back pain (LBP) and other conditions.

Yet it is not clear if physical modalities in addition to manipulation are effective forms of therapy, or if they increase the efficacy of manipulation.

To evaluate the net effect of physical modalities for treating LBP in chiropractic patients, 172 LBP patients were randomized to chiropractic care with modalities, while 169 LBP patients were randomized to chiropractic care without them. Modalities consisted of one or more of the following, utilized at the DC's discretion: heat or cold therapy, EMS, and ultrasound. LBP intensity average and intensity per week, determined on numerical rating scales, and LBP-related disability on a 24-item Roland-Morris Disability Questionnaire were assessed at two, four, and six weeks, and again at six months.

Results: Differences in improvements in average/severe weekly pain and disability were clinically insignificant between the two groups at all follow-up evaluations. Somewhat significant improvements in pain and disability were more probable in the modalities group at the two- and six-week assessments, but had vanished at the six-month follow-up. Patients' perceptions of treatment effectiveness were higher in the group receiving modalities; however, there was no difference between groups regarding overall satisfaction with care.

The authors conclude that physical modalities may provide only short-term benefits for LBP patients using chiropractic care, although specific modalities might be effective in some patients or in particular settings. They write: "Given the added expense of office-based modalities, chiropractors may deliver equally effective and more cost-effective care by withholding modalities, educating patients, and perhaps recommending at-home applications of agents for the temporary relief of symptoms."

Hurwitz EL, Morgenstern H, Harber P, et al. The effectiveness of physical modalities among patients with low back pain randomized to chiropractic care: Findings from the UCLA Low Back Pain Study. Journal of Manipulative and Physiological Therapeutics 2002:25(1), pp. 10-20.

Chiropractic Research Review

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