Low back pain (LBP) is tiredness, discomfort or pain in the low back. It is experienced by 70% to 80% of adults at some time during their lives. In Canada, it is estimated that medical expenditure on LBP costs $6 billion to $12 billion annually. In addition, there are societal costs due to lost productivity from days off work and disability payments.
Chiropractic care is a common treatment for LBP. Public funding support for chiropractic care varies across the provinces and territories in Canada. A clinical and economic review of chiropractic care for LBP was done because there is uncertainty about clinical and cost effectiveness compared with standard medical treatment or physical therapy; and there is variability in public funding for this treatment across Canada.
Methods and Results
Chiropractic care was compared with physical therapy and standard medical care for effectiveness and costs of treatment for LBP. Effectiveness was primarily determined by examining evidence from existing systematic reviews. Eighteen review articles were identified after screening available literature. Four trials published after the reviews were completed, were also identified. Relative costs were examined from 10 identified economic studies (four cost comparisons and six cost-consequence studies). Nine of the included economic studies were from the US and one was from Australia. None of the included studies were full cost-effectiveness studies. Implications for Decision Making
There is no clear clinical advantage to chiropractic treatment for LBP versus standard medical care or physical therapy. Studies show that the three treatment methods have similar effects on pain relief and functional improvement. The higher quality reviews did not find significant differences in effectiveness.
There is no clear cost advantage for any of the three methods studied. One of the included economic studies compared chiropractic care with physical therapy; and found costs to be similar. Cost results varied among the studies comparing chiropractic care with standard medical care. In terms of improving lost time from work, chiropractic care was similar to physical therapy; and as effective as or better than standard medical care.
Regional costs will require consideration. The impact on regional health care budgets will need to be considered when decisions on the funding of chiropractic care for LBP are being made. A well-designed Canadian study that compares the cost-effectiveness of LBP care provided by chiropractors, physical therapists and primary care physicians would be of benefit.