“Typical” chiropractic patients– can they be described in terms of recovery patterns?

Iben Axén, Charlotte Leboeuf-Yde

Chiropractors expect the typical patient to recover fully or to improve quickly with treatment if relapses occur. However, a mismatch between expectations and outcome would have a negative effect on both the chiropractors' professional self-esteem and patients' satisfaction with care. The prevalence of three types of recovery patterns among patients with non-specific low back pain (LBP) was calculated: 1: A full sustained recovery. 2: Initial recovery, but with one or several relapses followed by a period of recovery. 3: No initial recovery, but at least one period of recovery during the six month course of the study. Also, the number of patients classified as recovered at the end of the study was calculated. In this Swedish clinical observational study from 2008 to 2009, an automated text message system (SMS-Track®) was used to ask chiropractic patients weekly for 6 months about the number of days their LBP had bothered them during the past week. Data were analyzed blindly by two researchers by viewing individual graphs and was performed twice. In all 176 of 262 patients with non-specific LBP were included in the analysis. 1) Twenty percent of patients (CI: 15.3-26.9) made a full sustained recovery. 2) A further 20% (CI: 14.8-26.2) recovered initially but experienced a relapse, followed by at least one new period of full recovery. 3) Twenty-three percent (CI: 17.3-29.3) of patients failed to recovery initially but experienced recovery some time during the study. 4) Thirty-seven percent (CI: 30.3-44.1) had no periods of recovery, and were therefore classified as having a non-favorable course. At the end of the study, 41% (CI: 34.1-48.1) were classified as recovered. The results from this study can be used to introduce a realistic approach to chiropractic care in LBP, which should reduce disappointments among both chiropractors and patients. There was no "typical" recovery pattern. Trajectories were, in fact, spread over several subgroups with somewhat more than half reporting a favorable course but only one fifth enjoyed early and sustained recovery. Further, from a research perspective, the end-of -study status does not well depict the outcome experienced by patients.