Clinical Question: Is physical therapy an effective adjunct to medical care or chiropractic care in patients with low back pain?

Setting: Outpatient (any)

Study Design: Randomized controlled trial (nonblinded)

Synopsis: Researchers identified adult patients with low back pain who had not been treated in the previous month. They appropriately excluded patients with workers’ compensation issues. The team randomly assigned patients (masked allocation) to medical care (n = 170), medical care with physical therapy (n = 170), chiropractic care (n = 169), and chiropractic care with other modalities (including physical therapy and other modalities; n = 172). The main outcomes assessed via intention-to-treat included measures of pain and disability. Researchers followed the patients for six months and found that the greatest reduction in pain occurred in the first two weeks (average, 1.5 points on a 10-point scale). At six months, all groups improved, but the differences in outcomes across the four groups were clinically insignificant. Unfortunately, the researchers do not report whether the study was large enough to find a difference if one truly exists (i.e., the study may not have had enough power to find small differences).

Bottom Line: This study found little difference in outcomes for patients with low back pain treated medically or with chiropractic methods. Adding physical therapy to either approach did not result in greater improvement. The greatest pain reduction occurred within the first two weeks. (Level of Evidence: 1b)