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Back pain patients seen by chiropractors receive more information and advice than those seen by physicians

One-third as many patients with low back pain go to chiropractors for relief as to medical doctors, and studies suggest that they are more satisfied with chiropractic care. That's because chiropractors are more likely to explain their treatment for low back pain to their patients and to advise them about self-care once they get home, explains Hal Morgenstern, Ph.D., of the University of California, Los Angeles School of Public Health.

In the study, which was supported by the Agency for Healthcare Research and Quality (HS07755), Dr. Morgenstern and his colleagues randomized 672 patients in a managed care organization with low back pain (with or without leg pain) that had begun more than a year prior to the study, to receive either medical or chiropractic care.

Chiropractic patients reported receiving more self-care advice than did medical patients; they were more likely to receive an explanation of their treatment; and they visited their primary providers more often. The mean care satisfaction score (on a 10-50 scale, from least to most satisfied) after 4 weeks of followup for chiropractic patients was 5.5 points higher than the score for medical patients (36.1 vs. 30.6). Clinical improvement during the first 2 weeks of followup, more and longer visits to the provider, and initial confidence with the assigned treatment were associated with greater satisfaction at 4 weeks.

Receipt of self-care advice and explanation of treatment had strong estimated effects on patient satisfaction in this study. The difference in mean satisfaction scores between chiropractic and medical patients nearly disappeared (to 0.1) for patients who received an explanation of their treatment and at least four items of self-care advice (for example, advice on diet, weight loss, stress reduction, or specific ways to manage back pain such as moist heat or a back brace). These findings are consistent with previous studies that demonstrate associations between the amount of information patients receive and their degree of satisfaction, concludes Dr. Morgenstern.

See "Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: Results from the UCLA low-back pain study," by Ruth P. Hertzman-Miller, M.D., M.P.H., Dr. Morgenstern, Eric L. Hurwitz, D.C., Ph.D., and others, in the October 2002 American Journal of Public Health 92(10), pp. 1628-1633.

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