Helge - 14 October 2011 10:09 AM
As I thougth! Heres a link to the WHOLE study. http://www.worksafebc.com/contact_us/research/funding_decisions/assets/pdf/RS2004/RS2003_04_007.pdf
OK, there’s no mention of work loss here at all, so I’m not sure where that sentence came from. But the rest is exactly as I’d feared. The link demonstrates why this is a worthless study, even setting aside that it’s a very small sample size. Quoting from the paper (pp. 6-7):
Patients randomized to received GCT then received reassurance regarding the natural history of acute mechanical lower back pain; advice to avoid certain passive treatments (e.g. bed rest, heat or the use of back supports/corsets/braces), advice to participate in mild aerobic exercise (e.g. carry out a progressive walking program comprised of two walks a day, each with an initial duration set to the patient’s tolerance, starting with between five and 15 minutes, and adding two minutes a week to each walk); acetaminophen 650 mg every six to eight hours when required for pain for a period of two to four weeks, except when medically contraindicated (e.g. allergy, compromised liver function, acute porphyria); and a maximum four week course of lumbar spinal manipulative therapy using conventional side posture, high velocity, low amplitude techniques (i.e. no other areas of the spine were treated and specifically the patients did not receive any manipulation of the cervical spine). Spinal manipulation was administered two to three times per week at the discretion of the attending Chiropractor for a maximum of eight weeks. GCT group patients were also advised to avoid guideline-discordant treatments including the use of muscle relaxant and opioid-class medications, passive physiotherapy modalities, bed rest and “special” back exercise programs (e.g. “core stability” or extension exercises).
Patients randomized to the usual care / GDT treatment arm were advised of their diagnosis (i.e. acute mechanical lower back pain) and referred back to their referring family physician with a letter that explained the protocol of the current study. No specific treatment recommendations were made by the CNOSP physician.
So, in the first case the patients were given:
(1) Reassurance about the history of their symptoms
(2) Advice to avoid bed rest (which is known to be bad for lower back pain).
(3) Advice to do aerobic exercise (which is known to be good for reducing stress).
(4) Continual use of Acetaminophen (which is known to reduce pain generally).
(5) Back massage 2-3 times a week for 8 weeks (which is known to reduce stress).
(6) Advice to avoid certain other techniques
vs. in the second case the patients were given:
(1) Referral to family physician. (Which tells us precisely nothing).
There was no followup or tracking of what the family physicians did or did not do with their patients. No attempt to control for variables having nothing to do with supposed chiropractic care (reassurance, exercise, acetaminophen, etc.) And no apparent awareness that massage is good for reducing stress levels and lower back pain is typically stress related, something that is consistent with normal medical practice and that has nothing to do with the whole rigmarole of chiropractic quackery.
This study appears designed for marketing purposes rather than to actually elucidate anything. They might as well have termed it, “Acetaminophen and Aerobic Exercise Hospital Based Research Outcomes”, but that wouldn’t get them the headline they were looking for when they thought up this regime.
...agreed then. Dumb it is.
