Background
Methods
Design
Participants
Intervention
Pain and disability scales
Outcome measures
Predictive measures
Baseline Mean (SD) (N = 391) | Responder model significance | Future Pain Intensity model significance | |
---|---|---|---|
Dose (per 6 spinal manipulation visits) | † | † | |
Time (in weeks | |||
Pain/Disability | |||
Pain intensity (0–100 scale) | 51.6 (17.2) | † | |
Functional disability (0–100) | 45.3 (22.7) | † | |
Pain unpleasantness (0–100) | 41.4 (21.4) | † | |
Days with pain (last 4 wk) | 24.1 ( 5.2) | † | |
Days with disability (last 4 wk) | 6.8 ( 7.6) | † | |
Duration (yr) | 11.8 ( 9.8) | ||
Sociodemographics | |||
Age (yr) | 41.3 (14.1) | ||
Female, % (n) | 50 % (196) | ||
Non-white or Hispanic, % (n) | 15 % (58) | ||
College degree, % (n) | 56 % (219) | ||
Income $40 K or less, % (n) | 57 % (222) | ||
General Health | |||
Comorbidities (#) | 0.9 ( 1.1) | † | |
Smoking, % (n) | 11 % (43) | ||
SF-12 physical health componentb | 43.3 ( 8.9) | † | |
SF-12 mental health componentb | 48.9 (10.5) | ||
EuroQol – VAS (0–100 visual analog scale) | 70.9 (15.8) | † | † |
EuroQol 5D – mobility (1–3) | 1.4 ( 0.5) | † | |
EuroQol 5D – self-care (1–3) | 1.2 ( 0.4) | † | † |
EuroQol 5D – usual activities (1–3) | 1.7 ( 0.5) | † | |
EuroQol 5D – pain (1–3) | 2.0 ( 0.2) | † | |
EuroQol 5D – anxiety/depression (1–3) | 1.4 ( 0.5) | † | |
Psychosocial | |||
FABQ Work beliefs (0–100) | 32.9 (21.8) | † | |
FABQ Activity beliefs (0–100) | 56.0 (20.3) | † | |
Confidence in treatment success (−6 - +6) | 0.2 ( 0.8) | ||
Objective Physical Exam c | |||
Lumbar ROM: flexion | 43.2 (16.3) | ||
Lumbar ROM: extension | 15.1 (10.2) | ||
Lumbar ROM: right lateral bending | 18.6 ( 9.4) | ||
Lumbar ROM: left lateral bending | 19.1 ( 8.9) | ||
LBP: Flexion (0–10) | 2.3 ( 2.4) | † | † |
LBP: Extension (0–10) | 3.0 ( 2.4) | † | |
LBP: Right lateral bending (0–10) | 2.7 ( 2.4) | † | † |
LBP: Left lateral bending (0–10) | 2.6 ( 2.3) | † | † |
LBP: sum for 4 lumbar ROM 0–10 pain scores | 10.7 ( 7.9) | † | † |
LBP: maximum of 4 lumbar ROM pain scores | 4.0 ( 2.3) | † | |
LBP: right – left lateral bending | 0.1 ( 1.9) | ||
LBP: |right – left lateral bending| | 1.2 ( 1.5) | ||
LBP: sum for right and left lateral bending pain scores | 5.3 ( 4.3) | † | † |
LBP: maximum of right and left lateral bending pain scores | 3.2 ( 2.4) | † | † |
Modified Schober Test (cm) | 5.7 ( 2.0) | ||
Lumbar hypomobility: L1, % (n) | 54 % (209) | † | |
Lumbar hypomobility: L2, % (n) | 52 % (200) | ||
Lumbar hypomobility: L3, % (n) | 49 % (189) | ||
Lumbar hypomobility: L4, % (n) | 49 % (191) | ||
Lumbar hypomobility: L5, % (n) | 64 % (248) | ||
Total hypomobile joints: L1 thru L5 | 2.7 ( 1.3) | ||
Pain Pressure Threshold: right L1-L2 | 6.1 ( 2.8) | ||
Pain Pressure Threshold: left L1-L2 | 6.2 ( 2.9) | ||
Pain Pressure Threshold: right L3-L4 | 5.9 ( 3.0) | ||
Pain Pressure Threshold: left L3-L4 | 6.0 ( 3.2) | ||
Pain Pressure Threshold: right L5-S1 | 5.8 ( 3.2) | † | |
Pain Pressure Threshold: left L5-S1 | 5.7 ( 3.3) | † | |
Pain Pressure Threshold: minimum of 6 measures | 4.5 ( 2.5) | † |
Analysis
Model development
Model evaluation
Results
Pretreatment variables
Pretreatment multivariate predictor models
Responders (N = 297/94)b | Future pain intensity (N = 289/94)b | ||||||
---|---|---|---|---|---|---|---|
Independent variables | OR | (95 % CI) | P-value | β | (95 % CI) | P-value | |
Dose (per 6 spinal manipulation visits) | 1.27 | (1.08, 1.49) | 0.004 | −1.86 | (−3.35, −0.38) | 0.014 | |
Pain/Disability | |||||||
Pain intensity | 4.77 | (1.85, 7.70) | 0.001 | ||||
Pain unpleasantness | 3.29 | (0.35, 6.24) | 0.028 | ||||
General Health | |||||||
Comorbidities | 0.81 | (0.67, 0.97) | 0.025 | ||||
EuroQol – VAS | −2.20 | (−4.00, −0.39) | 0.017 | ||||
EuroQol 5D – self-care (1–3) | 0.64 | (0.41, 0.99) | 0.044 | ||||
Objective Physical Exam | |||||||
LBP: sum for 4 lumbar ROM pain scores | 0.81 | (0.67, 0.97) | 0.024 | 2.89 | (0.61, 5.16) | 0.013 | |
Performance metricsc | AUC | (95 % CI) | RMSE | (95 % CI) | R2 | (95 % CI) | |
Training set | 0.624 | 17.4 | .268 | ||||
Test set | 0.479 | (0.387, 0.575) | 19.4 | (17.0, 21.6) | .065 | (−10.5, 21.9) |
Post-treatment variables
Post-treatment (six-week) variables | Post-treatment Mean (SD) (N = 385) | Responder models | Future pain intensity models |
---|---|---|---|
Dose (per 6 spinal manipulation visits) | |||
Time (in weeks) | |||
Pain/Disability (6wk) | |||
Pain intensity (0–100) | 30.9 (17.2) | † | † |
Functional disability (0–100) | 27.7 (20.1) | † | † |
Perceived change in pain (1–6) | 4.2 (0.9) | † | † |
Perceived change in pain score (−100 to 100) | −38.3 (33.0) | † | † |
Perceived change in disability (1–6) | 3.9 (0.9) | † | † |
Number of outside care visits prior 4 weeks | 0.1 (1.3) | † | |
Pain unpleasantness (0–100 scale) | 19.6 (18.9) | † | † |
Days with pain (last 4 wk) | 16.9 (10.5) | † | † |
Days with disability (last 4 wk) | 1.6 ( 3.8) | † | |
Psychosocial (6wk) | |||
Satisfaction with chiropractor’s time listening (1–5) | 4.7 ( 0.7) | † | † |
Satisfaction with chiropractor’s comfort treating LBP (1–5) | 4.8 ( 0.5) | † | |
Satisfaction with chiropractor’s enthusiasm for treatment (1–5) | 4.5 ( 0.8) | † | |
Satisfaction with chiropractor’s confidence in treatment (1–5) | 3.5 ( 1.0) | † | † |
Mean satisfaction with chiropractor (1–5) | 4.4 ( 0.5) | † | † |
Confidence treatment is working (1–7) | 4.9 ( 1.7) | † | † |
Objective Physical Exam (6wk)b | |||
Lumbar ROM: flexion | 45.5 (17.6) | ||
Lumbar ROM: extension | 17.0 ( 9.5) | ||
Lumbar ROM: right lateral bending | 20.9 ( 9.7) | ||
Lumbar ROM: left lateral bending | 20.5 ( 9.6) | ||
LBP: flexion (0–10) | 1.1 ( 1.8) | † | † |
LBP: extension (0–10) | 1.7 ( 2.0) | † | † |
LBP: right lateral bending (0–10) | 1.4 ( 1.9) | † | † |
LBP: left lateral bending (0–10) | 1.3 ( 1.7) | † | † |
LBP: sum for 4 lumbar ROMs pain scores (each 0–10) | 5.4 ( 6.1) | † | † |
LBP: maximum of 4 lumbar ROMs pain scores | 2.5 ( 2.2) | † | † |
LBP: right – left lateral bending | 0.1 ( 1.4) | † | † |
LBP: |right – left lateral bending| | 0.8 ( 1.2) | † | † |
LBP: sum for right and left lateral bending pain scores | 2.7 ( 3.4) | † | † |
LBP: maximum of right and left lateral bending pain scores | 1.7 ( 2.0) | † | † |
Modified Schober Test (cm) | 21.0 ( 1.9) | ||
Lumbar hypomobility: L1 % (n) | 43 % (157) | ||
Lumbar hypomobility: L2 % (n) | 38 % (138) | ||
Lumbar hypomobility: L3 % (n) | 27 % (100) | ||
Lumbar hypomobility: L4, % (n) | 29 % (104) | † | † |
Lumbar hypomobility: L5, % (n) | 43 % (155) | † | † |
Total hypomobile joints: L1 thru L5 | 1.8 ( 1.3) | † | † |
Pain Pressure Threshold: right L1-L2 | 6.8 ( 3.7) | ||
Pain Pressure Threshold: left L1-L2 | 6.8 ( 3.0) | † | |
Pain Pressure Threshold: right L3-L4 | 6.7 ( 3.3) | † | |
Pain Pressure Threshold: left L3-L4 | 6.8 ( 3.2) | † | |
Pain Pressure Threshold: right L5-S1 | 6.7 ( 3.4) | † | |
Pain Pressure Threshold: left L5-S1 | 6.8 ( 3.5) | † | |
Pain Pressure Threshold: minimum of 6 measures | 5.4 ( 2.7) | † |
Post-treatment multivariate predictor models
Responders (N = 249/93)b | Future pain intensity (N = 262/93)b | ||||||
---|---|---|---|---|---|---|---|
Independent variables | OR | (95 % CI) | P-value | β | (95 % CI) | P-value | |
Dose (per 6 spinal manipulation visits) | 1.14 | (0.95, 1.37) | 0.150 | −0.07 | (−1.35, 1.21) | 0.910 | |
Time (in weeks) | 1.08 | (1.02, 1.14) | 0.004 | ||||
Pain/Disability | |||||||
Pain intensity | 0.64 | (0.51, 0.80) | <0.001 | 10.7 | (8.84, 12.56) | <0.001 | |
Days with pain (last 4 weeks) | 0.57 | (0.46, 0.70) | <0.001 | ||||
Objective Physical Exam | |||||||
LBP: right – left lateral bending | 0.76 | (0.63, 0.92) | 0.005 | ||||
LBP: right lateral bending | 2.95 | (1.21, 4.69) | 0.001 | ||||
Performance metricsc | AUC | (95 % CI) | RMSE | (95 % CI) | R2 | (95 % CI) | |
Training set | 0.750 | 16.3 | .366 | ||||
Test set | 0.665 | (0.58, 0.74) | 17.5 | (15.0, 20.1) | .261 | (7.5, 43.2) |