Symptomatic Outcomes and Perceived Satisfaction
Levels of Chiropractic Patients with a Primary
Diagnosis Involving Acute Neck Pain

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   J Manipulative Physiol Ther 2006 (May);   29 (4):   288–296 ~ FULL TEXT

Michael T. Haneline, DC, MPH

Palmer College of Chiropractic West,
San Jose, California 95134, USA.
michael.haneline@palmer.edu

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Acute Neck Pain: Significant Relief, Satisfaction With Chiropractic Treatment Thanks to Chiropractic Research Review for access to their comments! Commentary:     Neck pain, whether chronic or acute, is nearly as prevalent in the American adult population as back pain; estimates show that up to two-thirds of all American adults will suffer from neck pain at some point in their lives. While millions of chiropractic manipulations are performed in the United States each year for the treatment of neck pain, relatively little investigative research has been conducted regarding the treatment of neck pain with chiropractic manipulation, and even less research has been conducted on the use of chiropractic care to treat acute neck pain. The purpose of this two-part retrospective survey was to determine the extent to which patients with acute neck pain benefited from chiropractic manipulative therapy, and the degree to which they were satisfied with the care they received. Part one evaluated various aspects of chiropractors' treatment of 94 patients (60 women, 34 men; average age 39.6 years) suffering from acute neck pain. In part two, patients responded to a telephone survey to measure pre- and post-treatment pain levels, along with their level of satisfaction with the treatment they received.

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OBJECTIVE:   The aim of this study was to determine the extent to which a group of patients with acute neck pain managed with chiropractic manipulative therapy benefited from chiropractic care and the degree to which they were subsequently satisfied.

METHODS:   A two-part retrospective survey, each composed of 14 questions. One part was completed by practicing doctors of chiropractic concerning various aspects of their treatment for patients with former acute neck pain. In the second part, these same patients responded to a telephone survey to measure pre- and posttreatment pain levels and their level of satisfaction with the treatment they received. Chiropractic manipulative therapy was the primary independent variable, although other therapies were used, such as physical therapy, nutritional advice, and exercise.

RESULTS:   A total of 115 patients were contacted, of whom 94 became study participants, resulting in 60 women (64%) and 34 men. The mean age was 39.6 years (SD, 15.7). The mean number of visits was 24.5 (SD, 21.2). Pain levels improved significantly from a mean of 7.6 (median, 8.0) before treatment to 1.9 (median, 2.0) after treatment (P < .0001). The overall patient satisfaction rate was 94%.

CONCLUSION:   Patients with acute neck pain involved in this study seemed to be satisfied with chiropractic treatment and reported reductions in associated pain levels and activity restrictions. However, because of the study's design and limitations, care must be taken before drawing firm conclusions from the data presented.

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From the Full-Text Article:

Introduction

Neck pain is widespread in the general population, affecting approximately 67% of adults in the United Sates at some point in their lives. Prevalence estimates range from 13% to 18%, with women being affected at a higher rate than men. [1, 2] Neck pain, along with other neuromusculoskeletal system (NMS) disorders, has an enormous impact on public health in relation to disabilities, medical expenses, and lost work productivity. For instance, in the Netherlands, NMS disorders are responsible for up to 26% of all functional disability. [3]

Millions of chiropractic manipulations are performed every year for neck pain in the United States. [4–6] Yet, very little information is available in the medical or chiropractic literature related to the chiropractic treatment of neck pain. When specifically considering acute neck pain, little research has been published; consequently, reliable data are lacking. [7, 8] Available studies have shown benefit in relation to cervical manipulation for the treatment of tension and migraine headaches, nonspecific neck pain, and chronic whiplash syndrome. [9–11]

Cassidy et al [12] carried out a randomized clinical trial that investigated whether a single cervical manipulation was more effective than mobilization in decreasing neck pain and increasing cervical range of motion. Although the study determined that manipulation was more effective than mobilization in decreasing neck pain and increasing cervical rotation, it had limited generalizability. It is difficult to determine how many of the subjects experienced acute neck pain because pain was present for less than 1 week in only 16 patients. Pain extended from 1 week to 6 months in 34 subjects, whereas the remaining 50 subjects had pain for more than 6 months. As a result, the sample size of acute subjects was less than 50, producing a statistical analysis with very low power. Furthermore, the patients only received one manipulation, which differs from typical chiropractic practice. Generally speaking, doctors of chiropractic (DCs) provide numerous manipulations in the course of treating a patient for an NMS condition.

A pilot study was recently carried out by Evans et al [13] which dealt with acute or subacute neck pain of less than 12 weeks' duration. There was a total of 28 subjects involved, with 10 being randomly assigned to a manipulation group. The authors made no comparisons between groups because of small sizes; rather, the information was used in preparation for a complete randomized controlled trial in the future.

Chiropractic manipulative therapy (CMT) is not the only modality lacking validity in relation to neck pain treatment. The Philadelphia Panel investigated neck pain in general and determined that only 8 clinical trials met all of their selection criteria for the management of neck pain; although none of the trials that they included involved CMT. Moreover, only proprioceptive and therapeutic exercise for chronic neck pain showed clinical benefit for pain and function, and no studies supported any form of treatment of acute neck pain. [14]

The issue of patient satisfaction has been investigated mainly in relation to the treatment of chronic neck pain by spinal manipulation. Patients have generally been satisfied with spinal manipulative therapy in these studies, especially when it was combined with exercise. [15–17] Patients most likely to seek treatment from DCs are those with lower back or neck pain, [18] and there is evidence that CMT is safe and cost-effective for the treatment of these conditions. [19] One large study revealed that 46% of patients presenting to DCs had lower back pain, 12.7% had neck pain, and the remaining patients had various complaints such as headaches, allergies, and sinus pain. [20] However, cervical CMT is performed during the course of 66% to 69% of chiropractic visits. [21]

The purpose of this study was to determine whether a group of patients with acute neck pain benefited from CMT and the extent to which they were satisfied with the treatment. Additional observational data are presented regarding several other variables that were collected from both the DCs and patients who participated in the study.

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Discussion

This study, representing data from 94 patients who attended a total of 2303 chiropractic office visits, showed that the treatment for patients with acute neck pain by chiropractic methods may be beneficial. Participating patients, for the most part, indicated that they noticed less pain and disability after treatment. They also indicated that they were satisfied with the care that they received, and most of them would choose similar care for an episode of the same condition in the future.

      Patient Satisfaction

The overall patient satisfaction level was determined to be 94% when including all patients who reported that they were either satisfied or very satisfied with their care. This level was better than anticipated because it was higher than previous reports. Although there are no studies available for direct comparison that have reported satisfaction levels regarding the treatment of acute neck pain by CMT, Wolsko et al [27] reported that chiropractic was rated as “very helpful” by 61% of those respondents who received treatment of back or neck pain. In addition, Jordan et al [17] reported “good” satisfaction with chiropractic manipulative treatment in a group of patients with chronic neck pain.

Treatment adherence may be another indicator of how satisfied patients were with the care they received, although this supposition has not been investigated. The rationale for this statement is that if patients are satisfied with the treatment they receive, they will be more likely to follow through and complete their treatment plan. If not, they may decide to try another method of treatment and discontinue care. Generally speaking, treatment adherence was fair in this study, given that nearly two thirds of the patients completed their treatment plan.

      Pain Reduction

In the study's group of acute patients, mean neck pain levels before treatment were nearly 4 times greater than they were at the completion of treatment. Furthermore, after at least 1 year since the patients' initial visit, the study yielded mean pain reductions of 5.6 points. In comparison, a study by Hurwitz et a [l8] reported mean reductions of average neck pain on a mixed group composed of acute, subacute, or chronic chiropractic patients, also using an 11–point scale. At follow-up 6 months after the initial visit, there was a two-point reduction of pain. Another mixed group study by Cassidy et al [28] reported improvement of neck pain before and after CMT using the 101–point numerical rating (NRS-101) scale. They indicated that before treatment mean, NRS-101 scores were 43.7, compared with 31.1 after treatment. Because the NRS-101 scale is a progressive numerical scaling method from 1 to 100, this measurement would approximate a 1.3–point reduction on the 11–point scale. However, treatment only involved one CMT to the neck, and pain levels were ascertained immediately after treatment.

      Reduction of Disability

There were reductions in disability recorded during the study that were statistically significant. Approximately 84% of the patients related that their activities were restricted before chiropractic treatment because of their neck pain, whereas only 25% still had activity restrictions at the time of the interview. Furthermore, 57% of those with physical restrictions described their disabilities as moderately severe or greater before treatment, whereas at the time of the interview, just 12% did. No studies have addressed the issue of disability reduction regarding a group exclusively composed of patients with acute neck pain. For comparison, however, Hurwitz et al [l8] used the Neck Disability Index, which uses a point scale of 0 to 50 to evaluate a mixed group of neck pain patients. The researchers noted a decrease of more than 6 points at 6–month follow-up. In a study of CMT and chronic neck pain, Jordan et al [17] rated disability using a scale with a maximal point score of 30. Self-reported disability showed improvements that showed approximately a 50% reduction. This compares to more than a 50% reduction in this current study.

Women had a higher proportion of activity restriction than men, which was determined to be statistically significant. This finding is similar to what has been apparent in outcome studies of automobile crash–related neck injuries. In effect, women sustained long-term consequences more often than men after whiplash injuries. [29]

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