The Spine Journal
Volume 10, Issue 12 , Pages 1055-1064 , December 2010

The Chiropractic Hospital-based Interventions Research Outcomes (CHIRO) Study: a randomized controlled trial on the effectiveness of clinical practice guidelines in the medical and chiropractic management of patients with acute mechanical low back pain

  • Paul B. Bishop, DC, MD, PhD

      Affiliations

    • International Collaboration on Repair Discoveries (ICORD), 6110-818 West 10th Ave., University of British Columbia, Vancouver, British Columbia, Canada V5Z 1M9
    • Combined Neurosurgical and Orthopaedic Spine Program, Division of Spine, Department of Orthopaedics, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, British Columbia, Canada V5Z 1M9
    • Corresponding Author InformationCorresponding author. International Collaboration on Repair Discoveries (ICORD), Blusson Spine Centre, University of British Columbia, 6110-818 West 10th Ave., Vancouver, British Columbia, Canada V5Z 1M9. Tel.: (604) 875-4549; fax: (604) 875-5858.
    • ,
  • Jeffrey A. Quon, DC, PhD, FCCSC

      Affiliations

    • School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada V6T 1Z3
    • ,
  • Charles G. Fisher, MD, MHSc, FRCSC

      Affiliations

    • International Collaboration on Repair Discoveries (ICORD), 6110-818 West 10th Ave., University of British Columbia, Vancouver, British Columbia, Canada V5Z 1M9
    • Combined Neurosurgical and Orthopaedic Spine Program, Division of Spine, Department of Orthopaedics, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, British Columbia, Canada V5Z 1M9
    • ,
  • Marcel F.S. Dvorak, MD, FRCSC

      Affiliations

    • International Collaboration on Repair Discoveries (ICORD), 6110-818 West 10th Ave., University of British Columbia, Vancouver, British Columbia, Canada V5Z 1M9
    • Combined Neurosurgical and Orthopaedic Spine Program, Division of Spine, Department of Orthopaedics, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Vancouver, British Columbia, Canada V5Z 1M9

Received 13 January 2010 ,Revised 23 July 2010 ,Accepted 22 August 2010.

References 

  1. Bigos S, Bowyer O, Braen GR, et al. Clinical practice guideline number 14: acute low back problems in adults. Rockville, MD: Agency for Health Care Policy and Research, Public Service, US Department of Health and Human Services; 1994;65-0642
  2. Spitzer WO, Walter O. Scientific approach to the assessment and management of activity-related spinal disorders. A monograph for clinicians. Report of the Quebec Task Force on Spinal Disorders. Spine. 1987;12(7 Suppl):S1–S59
  3. Royal College of General Practitioners . Clinical guidelines for the management of acute low back pain. London, UK: Royal College of General Practitioners; 1999;Available at: www.rcgp.org.ukAccessed June 4, 2001
  4. Kendall NAS, Linton SJ, Main CJ. Guide to assessing psychological yellow flags in acute low back pain: risk factors for long-term disability and work loss. Wellington, NZ: Accident Rehabilitation & Compensation Insurance Corporation of New Zealand and the National Health Committee; 1997;
  5. Abenhaim L, Rossignol M, Valat JP, et al. The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain. Spine. 2000;25:1S–33S
  6. Bogduk N. Draft evidence based clinical guidelines for the management of acute low back pain. Australia: National Health and Medical Research Council; 2000;
  7. Central Board of Organization for Peer Review (CBO) . Consensus Lumbosacral Radicular Syndrome. Utrecht, The Netherlands: CBO; 1995;
  8. Treatment guideline–backache. Drug Committee of the German Medical Society. [in German] Z Arztl Fortbild Qualitatssich. 1997;91:457–460
  9. Hansen TM, Bendix T, Bünger CE, et al. Lower back pain report from the Danish Society of Internal Medicine. Ugeskr Laeger. 1996;158:1–18
  10. Keel P, Perinin CH, Schutz-Petitjean D, et al. Chronicity of back pain: problematic issues. Final report of program National de Recherche No. 26B. Bale Editions EULAR. 1996.
  11. Manniche C, Ankjær-Jensen A, Olsen A, et al. Low-back pain: frequency, management and prevention from an HTA perspective. Copenhagen: Danish Institute for Health Technology Assessment; 1999;
  12. Borkan J, Reis S, Werner S, et al. Guidelines for treating low back pain in primary care. The Israeli low back pain guideline group. Harefuah. 1996;130:145–151224
  13. Koes BW, van Tulder MW, Ostelo R, et al. Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine. 2001;26:2504–2513discussion 2513–4
  14. Bishop PB, Wing PC. Compliance with clinical practice guidelines in family physicians managing worker’s compensation board patients with acute lower back pain. Spine J. 2003;3:442–450
  15. Bishop PB, Wing PC. Knowledge transfer in family physicians managing patients with acute low back pain: a prospective randomized control trial. Spine J. 2006;6:282–288
  16. Gonzalez-Urzelai V, Palacio-Elua L, Lopez-de-Munain J. Routine primary care management of acute low back pain: adherence to clinical guidelines. Eur Spine J. 2003;12:589–594
  17. Steven ID, Fraser RD. Clinical practice guidelines. Particular reference to the management of pain in the lumbosacral spine. Spine. 1996;21:1593–1596
  18. Burton AK, Waddell G. Clinical guidelines in the management of low back pain. Baillieres Clin Rheumatol. 1998;12:17–35
  19. Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine. 1995;20:11–19
  20. Cherkin DC, Deyo RA, Wheeler K, Ciol MA. Physician views about treating low back pain. The results of a national survey. Spine. 1995;20:1–10discussion 9–10
  21. Roland M, Fairbank J. The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine. 2000;25:3115–3124
  22. Bombardier C, Hayden J, Beaton DE. Minimal clinically important 21 difference. Low back pain: outcome measures. J Rheumatol. 2001;28:431–438
  23. Constant F, Collin JF, Guillemin F, Boulange M. Effectiveness of spa therapy in chronic low back pain: a randomized clinical trial. J Rheumatol. 1995;22:1315–1320
  24. McGuirk B, King W, Govind J, et al. Safety, efficacy, and cost effectiveness of evidence-based guidelines for the management of acute low back pain in primary care. Spine. 2001;26:2615–2622
  25. UK BEAM Trial Team . United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ. 2004;329:1377
  26. Hancock MJ, Maher CG, Latimer J, et al. Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial. Lancet. 2007;370:1638–1643
  27. Suarez-Almazor ME, Kendall C, Johnson JA, et al. Use of health status measures in patients with low back pain in clinical settings. Comparison of specific, generic and preference-based instruments. Rheumatology (Oxford). 2000;39:783–790
  28. Bishop P, Fisher C, Quon J, Dvorak M. Clinical practice guideline-based treatment is not effective for all patients with acute lower back pain: a randomized controlled clinical trial. Spine J. 2008;8(Suppl):71S

 FDA device/drug status: not applicable.

 Author disclosures: MFSD (royalties, Medtronic; stock ownership, including options and warrants, Medtronic; consulting, Medtronic; research support: staff/materials, Medtronic; grants, Medtronic, DePuy Spine, Rick Hansen Foundation; fellowship support, Medtronic, Synthes, DePuy); CGF (royalties, Medtronic; consulting, Medtronic; speaking/teaching arrangements, Medtronic, DePuy, AO; trips/travel, Medtronic, DePuy, AO; research support: staff/materials, Medtronic, DePuy; fellowship support, Medtronic, Synthes).

PII: S1529-9430(10)01114-9

doi: 10.1016/j.spinee.2010.08.019

The Spine Journal
Volume 10, Issue 12 , Pages 1055-1064 , December 2010

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