The 130th Annual Meeting of APHA

3017.0: Monday, November 11, 2002 - 9:10 AM

Abstract #39280

Satisfaction as a predictor of clinical outcomes among chiropractic and medical patients enrolled in the UCLA Low-Back Pain Study

Eric L. Hurwitz, DC, PhD, Department of Epidemiology, UCLA School of Public Health, Box 951772, Los Angeles, CA 90095-1772, 310-206-4074,, Hal Morgenstern, PhD, Department of Epidemiology, University of California, Los Angeles, School of Public Health, Box 951772, Los Angeles, CA 90095-1772, and Fei Yu, PhD, Department of Epidemiology, UCLA, School of Public Health, 10833 Le Conte Ave., Los Angeles, CA 90095.

Recent studies of low-back-pain treatments have shown chiropractic patients to be more satisfied with their care than medical patients. However, little is known about the association between satisfaction and clinical outcomes. The purpose of this study is to estimate the effects of patient satisfaction on pain and disability among 681 low-back-pain patients followed up for 18 months in a randomized clinical trial of medical and chiropractic care. Following the initial 4-week treatment period, satisfaction was measured by telephone interview with a previously validated 10-item (0-40 points) patient satisfaction instrument. Low-back-pain intensity and frequency were assessed with 0-10 numerical rating and 6-point ordinal scales, respectively; low-back-related disability was assessed with the 24-item Roland-Morris Disability Questionnaire. Multivariable logistic and linear regression modeling with generalized estimating equations was used to estimate associations adjusted for the effects of potential confounders. For logistic modeling, the low-back scales were dichotomized at values reflecting clinically meaningful pain or disability, and a clinical remission variable created. Greater satisfaction increased the odds of remission from clinically meaningful pain and disability at 6 weeks (adjusted odds ratio [OR] for 10-point increase in satisfaction=1.61, 95% confidence interval [CI]=0.99, 2.61), but not at 6, 12, or 18 months (6 months: adjusted OR=1.02, 95% CI=0.72, 1.44; 12 months: adjusted OR=0.94, 95% CI=0.68, 1.29; 18 months: adjusted OR=1.06; 95% CI=0.78, 1.46). Type of provider did not affect the estimated associations. Patient satisfaction appears to confer short-term clinical benefits for low-back-pain patients.

Learning Objectives:

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Chiropractic Care of Pain: Costs and Outcomes

The 130th Annual Meeting of APHA