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Well-being outcomes of chiropractic intervention for lower back pain: a systematic review

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Abstract

The usefulness of chiropractic for treatment of low back pain is a contentious issue. Chiropractors advocate holism and general well-being as a key principle on which they base their clinical practice, yet the quality of life, lifestyle, health and economic impacts of chiropractic intervention for back pain in adults have rarely been investigated. This article provides an overview of chiropractic principles and practices, together with the results of a systematic review of peer-reviewed publications between 2000 and 2010 retrieved from MEDLINE, CINAHL, EMBASE, AMED and Cochrane Database of Systematic Reviews. This review sought to determine the benefits of chiropractic treatment and care to well-being, and to what extent chiropractic treatment and care improve quality of life. Of 1,165 articles, 12 articles were retained, representing six studies (four randomised controlled trial, two observational) of varying quality. There was a high degree of inconsistency and lack of standardisation in measurement instruments and outcome measures. Three studies reported reduced use of other/extra treatments as a positive outcome; two studies reported a positive effect of chiropractic intervention on pain, and two studies reported a positive effect on disability. The six studies reviewed concentrated on the impact of chiropractic care on physical health and disability, rather than the wider holistic view which was the focus of this study. It is difficult, therefore, to defend any conclusion about the impact of chiropractic intervention on the quality of life, lifestyle, health and economic impact on chiropractic patients presenting with back pain.

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Acknowledgments

All researchers in the Faculty of Health at the University of Newcastle are members of the Hunter Medical Research Institute (HMRI). We acknowledge Elodie Sprenger, Research Centre for Gender Health and Ageing, University of Newcastle, for assistance with literature searches and article retrieval, and Cassie Curryer, Research Centre for Gender Health and Ageing, University of Newcastle, for assistance with editing and manuscript preparation.

Disclosures

None.

Author information

Authors and Affiliations

  1. Health CRN, IHSSR, Central Queensland University Australia, Building 19/2.10, Rockhampton Campus, Bruce Highway, Rockhampton, Queensland, 4701, Australia

    Lynne Parkinson

  2. Faculty of Health, University of Technology Sydney, Sydney, Australia

    David Sibbritt

  3. School of Biomedical Sciences and Pharmacy, Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, New South Wales, Australia

    Philip Bolton

  4. Research Higher Degree Candidate, University of Newcastle, Newcastle, New South Wales, Australia

    Joan van Rotterdam

  5. Nineways Chiropractic Clinic, Newcastle, New South Wales, Australia

    Inger Villadsen

Authors
  1. Lynne Parkinson
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  2. David Sibbritt
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  3. Philip Bolton
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  4. Joan van Rotterdam
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  5. Inger Villadsen
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Corresponding author

Correspondence to Lynne Parkinson.

Appendix 1: final search terms and strategy

Appendix 1: final search terms and strategy

Search terms:

A: Back pain

  • General terms

    1. 1.

      back pain.mp. or exp Back Pain/

    2. 2.

      back injuries.mp. or exp Lumbar Vertebrae/ or exp Back Injuries/

    3. 3.

      exp Low Back Pain/ or low* back pain.mp.

    4. 4.

      lumbar pain.mp.

    5. 5.

      dorsalgia.mp.

    6. 6.

      lumbago.mp.

    7. 7.

      backache.mp.

    8. 8.

      exp Spinal Diseases/ or chronic back pain.mp.

    9. 9.

      exp Pain, Intractable/ or intractable back pain.mp.

    10. 10.

      spin* pain.mp.

    11. 11.

      acute back pain.mp.

    12. 12.

      back trauma.mp.

    13. 13.

      referred back pain.mp.

  • Specific causes of back pain and related terms

    1. 1.

      sciatica.mp. or exp Sciatica/

    2. 2.

      exp Cervical Vertebrae/ or spinal injur*.mp.

    3. 3.

      exp Intervertebral Disk Displacement/ or exp Intervertebral Disk/ or slipped disc.mp. or exp Spondylolisthesis/

    4. 4.

      slipped disk.mp.

    5. 5.

      exp Thoracic Vertebrae/ or disc protrusion.mp.

    6. 6.

      exp Spinal Stenosis/ or disk protrusion.mp.

    7. 7.

      disc extrusion.mp. or exp Spinal Cord Compression/

    8. 8.

      disk extrusion.mp.

    9. 9.

      hernia* disc.mp. or exp Lumbosacral Region/

    10. 10.

      hernia* disk.mp.

    11. 11.

      prolapse* disc.mp.

    12. 12.

      prolapse* disk.mp.

    13. 13.

      rupture* disc.mp. or exp Spinal Fractures/

    14. 14.

      rupture* disk.mp.

    15. 15.

      spin* degeneration.mp.

    16. 16.

      dis* degeneration.mp.

    17. 17.

      bulging disc.mp.

    18. 18.

      bulging disk.mp.

    19. 19.

      spondylosis.mp. or exp Spondylosis/ or exp Spinal Cord Diseases/

    20. 20.

      spondylolysis.mp. or exp Spondylolysis/

    21. 21.

      discitis.mp. or exp Discitis/

    22. 22.

      diskitis.mp.

    23. 23.

      compression fracture.mp. or exp Fractures, Compression/

    24. 24.

      ischialgia.mp.

    25. 25.

      sciatic nerve.mp. or exp Sciatic Nerve/

    26. 26.

      exp Arthritis/ or exp Arthritis, Rheumatoid/ or arthritis.mp.

    27. 27.

      exp Osteoporosis, Postmenopausal/ or exp Osteoporosis/ or osteoporosis.mp.

    28. 28.

      skeletal irregularities.mp.

    29. 29.

      exp Inflammation/ or inflammatory disease*.mp.

    30. 30.

      cancer.mp.

    31. 31.

      exp Rheumatic Diseases/ or exp Spondylitis, Ankylosing/ or ankylosing spondylitis.mp.

B: Quality of life

  1. 1.

    exp ‘Quality of Life’/ or health related quality of life.mp.

  2. 2.

    exp Morbidity/ or disease burden.mp.

  3. 3.

    mental health.mp. or exp Mental Health/

  4. 4.

    exp ‘Activities of Daily Living’/ or physical function*.mp.

  5. 5.

    social function*.mp.

  6. 6.

    vitality.mp.

  7. 7.

    emotional function*.mp.

  8. 8.

    bodily pain.mp.

  9. 9.

    general health.mp.

  10. 10.

    health status.mp. or exp Health Status/

  11. 11.

    disability.mp.

C: Lifestyle

  1. 1.

    exp Diet/ or diet.mp.

  2. 2.

    nutrition.mp.

  3. 3.

    exp Exercise/ or exercise.mp.

  4. 4.

    physical activity.mp. or exp Motor Activity/

  5. 5.

    over?weight.mp. or exp Overweight/ or exp Body Weight/

  6. 6.

    exp Obesity/ or exp Obesity, Morbid/ or exp Obesity, Abdominal/ or obesity.mp.

  7. 7.

    manual occupation.mp.

  8. 8.

    exp Occupational Exposure/ or exp Occupational Diseases/ or occupational disease*.mp.

  9. 9.

    posture.mp. or exp Posture/

  10. 10.

    sedentary lifestyle.mp. or exp Sedentary Lifestyle/ or exp Physical Exertion/ or exp Health Behavior/

  11. 11.

    physical fitness.mp. or exp Physical Fitness/

  12. 12.

    health behavio?r.mp.

  13. 13.

    lifestyle.mp. or exp Life Style/

  14. 14.

    physically strenuous work.mp.

  15. 15.

    satisfaction with life.mp.

  16. 16.

    social interaction.mp. or exp Interpersonal Relations/

  17. 17.

    family interaction.mp. or exp Social Adjustment/

  18. 18.

    activity participation.mp.

  19. 19.

    role performance.mp.

D: Health

  1. 1.

    exp Glucocorticoids/ or corticosteroid*.mp.

  2. 2.

    health outcome.mp.

  3. 3.

    headache.mp. or exp Headache/

  4. 4.

    pharmaceutical consumption.mp.

  5. 5.

    medicine consumption.mp.

  6. 6.

    medication consumption.mp.

  7. 7.

    drug utilisation.mp.

  8. 8.

    drug utilization.mp. or exp Drug Utilization/

  9. 9.

    co?morbid disease.mp. or exp Comorbidity/

  10. 10.

    exp Chronic Disease/ or chronic disease*.mp.

  11. 11.

    co?morbid condition*.mp.

  12. 12.

    cortisone.mp. or exp Cortisone/

E: Economic

  1. 1.

    economics.mp. or exp Economics/

  2. 2.

    health?care costs.mp. or exp Health Care Costs/

  3. 3.

    exp Health Expenditures/ or health?care expenditure.mp.

  4. 4.

    ‘Costs and Cost Analysis’/ or economic costs.mp. or exp ‘Cost of Illness’/

  5. 5.

    economic burden.mp.

  6. 6.

    indirect cost*.mp.

  7. 7.

    direct cost*.mp.

  8. 8.

    treatment cost*.mp.

  9. 9.

    exp Cost-Benefit Analysis/ or rehabilitation cost*.mp.

  10. 10.

    productivity loss.mp.

  11. 11.

    loss of earning*.mp.

  12. 12.

    loss of income.mp.

  13. 13.

    exp Drug Costs/ or pharmaceutical cost*.mp.

F: Chiropractic intervention

  1. 1.

    spin* manipulation.mp.

  2. 2.

    exp Manipulation, Chiropractic/ or exp Chiropractic/ or chiropractic.mp.

  3. 3.

    manual therapy.mp. or exp Musculoskeletal Manipulations/

  4. 4.

    chiropractic manipulation.mp.

  5. 5.

    manual therapies.mp.

  6. 6.

    manipulative therapy.mp.

  7. 7.

    manipulative therapies.mp.

  8. 8.

    exp Manipulation, Spinal/ or spinal manipulation therapy.mp.

  9. 9.

    mobilisation treatment.mp.

  10. 10.

    mobilization treatment.mp.

  11. 11.

    spin* adjustment.mp.

  12. 12.

    exp Complementary Therapies/ or complimentary therapies.mp.

  13. 13.

    complimentary therapy.mp.

  14. 14.

    alternative therapies.mp.

  15. 15.

    alternative therapy.mp.

  16. 16.

    alternative treatment*.mp.

  17. 17.

    complimentary treatment*.mp.

  18. 18.

    exp Physical Therapy Modalities/ or physical therapy.mp.

  19. 19.

    physical therapies.mp.

  20. 20.

    exp Complementary Therapies/ or complimentary therapies.mp. AND treatment outcome.mp. or exp Treatment Outcome/

  21. 21.

    exp Physical Therapy Modalities/ or physical therapy.mp. AND treatment outcome.mp. or exp Treatment Outcome/

  22. 22.

    alternative therapies.mp. AND treatment outcome.mp. or exp Treatment Outcome/

  23. 23.

    exp Manipulation, Chiropractic/ or exp Chiropractic/ or chiropractic.mp. AND treatment outcome.mp. or exp Treatment Outcome/

Search strategy: Back pain (general and specific) and quality of life, health economic and lifestyle impacts of chiropractic intervention (i.e. A + [B or C or D or E] + F).

Limits: English language; human; years 2000–2010; aged 18 and over; country of origin (Australia, USA, Canada, England, Denmark).

Exclusion criteria: Interventions that focus only on neck pain, chiropractic interventions performed by other healthcare professionals (e.g. physiotherapist, osteopath). These will be manually excluded at abstract cull stage.

Databases: MEDLINE, CINAHL, EMBASE, AMED, Cochrane Database of Systematic Reviews.

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Parkinson, L., Sibbritt, D., Bolton, P. et al. Well-being outcomes of chiropractic intervention for lower back pain: a systematic review. Clin Rheumatol 32, 167–180 (2013). https://doi.org/10.1007/s10067-012-2116-z

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  • DOI: https://doi.org/10.1007/s10067-012-2116-z

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