SIB# 400 - Chiropractic Compared to Physical Therapy
The Study: A Comparison of Physical Therapy and Chiropractic Manipulation
The Facts:
a. Low back pain (LBP) is very common and costly condition in the United States.
b. LBP patients commonly receive medical care in the form of injections and surgeries.
c. LBP also places a load on emergency room services.
d. It has been suggested that early treatment by physical therapists (PT) or chiropractors may result in a lowering of treatment costs.
e. “The purpose of this study was to investigate the cost-effectiveness of chiropractic versus PT in the U.S.”
f. “For data collection, Medline and PubMed databases were searched from 2000 to September 2018.”
g. “Chiropractic care and PT are shown to be the superior non-pharmacologic strategies for treating LBP, when compared to other non-pharmacologic treatments.”
h. However the literature does not demonstrate whether PT or chiropractic is optimal for acute low back pain.
i. Both Chiropractic and Physical Therapy have received significant criticism.
j. Included in the criticisms of chiropractic was one that, “…pointed at the adverse effects of X-ray imaging, which is essential for contemporary chiropractic.”
k. The study found in the short term that “…chiropractic care is a more cost-effective alternative compared to PT for the treatment of acute low back pain.”
l. “However, the marginal cost-effectiveness of chiropractic over PT.suggests that both treatments were quite similar.”
Take Home: This study noted that both physical therapy and chiropractic “…have been subject to much criticism.” They also noted that both were the superior non- pharmacological treatments for acute LBP and that chiropractic was marginally more cost effective than PT in the short term.
Reviewer's Comments: I am heartened that chiropractic care was more cost effective, if only marginally so. I would have expected that chiropractic would have been more cost effective. But I do have a question prompted by my listening to chiropractic researcher Dr. Greg Plaugher as to what type of chiropractic care was applied to these patients. The question should be not if chiropractic or PT was used, but what did that actually mean. For the chiropractic care, I would also like to know how they determined what type of care should be rendered, whether or not they used adjustments, more specifics on how the patients were adjusted, etc. So, although interesting, in some ways the study leaves many questions unanswered
Reviewer: Roger Coleman DC
Editor: Mark R. Payne DC
Reference: Khodakarami N. Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and ChiropracticManipulation. Healthcare (Basel). 2020 Feb 24;8(1). pii: E44. doi: 10.3390/healthcare8010044.
Link to Abstract: https://www.ncbi.nlm.nih.gov/pubmed/32102417
Link to Article: https://www.mdpi.com/2227-9032/8/1/44