Fisioterapia, Quiropraxia ou Educação

A COMPARISON OF PHYSICAL THERAPY, CHIROPRACTIC MANIPULATION,
AND PROVISION OF AN EDUCATIONAL BOOKLET FOR THE TREATMENT
OF PATIENTS WITH LOW BACK PAIN

DANIELC. CHERKIN, PHD., RICHARDA. DEYO, M.D., M.P.H., MICHELEBATTIÉ, PH.D., R.P.T.,JANETSTREET, M.N., C.P.N.P.,ANDWILLIAMBARLOW, PHD.

ABSTRACT

Background and Methods
There are few data on
the relative effectiveness and costs of treatments for
low back pain. We randomly assigned 321 adults
with low back pain that persisted for seven days after
a primary care visit to the McKenzie method of
physical therapy, chiropractic manipulation, or a minimal
intervention (provision of an educational booklet).
Patients with sciatica were excluded. Physical
therapy or chiropractic manipulation was provided
for one month (the number of visits was determined
by the practitioner but was limited to a maximum of
nine); patients were followed for a total of two years.
The bothersomeness of symptoms was measured
on an 11-point scale, and the level of dysfunction
was measured on the 24-point Roland Disability Scale.

Results
After adjustment for base-line differences,
the chiropractic group had less severe symptoms
than the booklet group at four weeks (P=0.02),
and there was a trend toward less severe symptoms
in the physical-therapy group (P=0.06). However,
these differences were small and not significant after
transformations of the data to adjust for their
non-normal distribution. Differences in the extent of
dysfunction among the groups were small and approached
significance only at one year, with greater
dysfunction in the booklet group than in the other
two groups (P=0.05). For all outcomes, there were
no significant differences between the physical-therapy
and chiropractic groups and no significant differences
among the groups in the numbers of days
of reduced activity or missed work or in recurrences
of back pain. About 75 percent of the subjects in the
therapy groups rated their care as very good or excellent,
as compared with about 30 percent of the
subjects in the booklet group (P<0 .001="" a="" br="" over="" twoyear="">period, the mean costs of care were $437 for the
physical-therapy group, $429 for the chiropractic
group, and $153 for the booklet group.

Conclusions
For patients with low back pain, the
McKenzie method of physical therapy and chiropractic
manipulation had similar effects and costs, and
patients receiving these treatments had only marginally
better outcomes than those receiving the minimal
intervention of an educational booklet. Whether
the limited benefits of these treatments are worth
the additional costs is open to question.

(N Engl J Med 1998;339:1021-9.)
©1998, Massachusetts Medical Society.

Dr. Bruno Cabral
Fisioterapeuta 
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