Spine www.spinejournal.com 2071 RANDOMIZED TRIAL SPINE Volume 38, Number 24, pp 2071-2078 ©2013, Lippincott Williams & Wilkins Short-Term Usual Chiropractic Care for Spinal Pain A Randomized Controlled Trial Bruce F. Walker, DC, MPH, DrPH,* Jeff J. Hebert, DC, PhD,† Norman J. Stomski, PhD ,* Barrett Losco, MChiropractic,* and Simon D. French, PhD‡ DOI: 10.1097/01.brs.0000435032.73187.c7 Study Design. Parallel-group randomized controlled trial. Objective. Establish the short-term effectiveness of chiropractic therapy for spinal pain compared with a sham intervention and explore the predictors of chiropractic treatment satisfaction. Summary of Background Data. Chiropractic treatment is widely used for spinal pain. However, a lack of sound evidence precludes conclusions about the effectiveness of chiropractic for spinal pain. Methods. Participants were adults experiencing spinal pain, randomized to receive 2 treatments of chiropractic or sham therapy. Participants and outcome assessors were blinded to group allocation. Primary outcomes at 2 weeks were pain intensity (0–10 scale) and function (0–40 Functional Rating Index). Secondary outcomes were global change, minimum acceptable outcome, and treatment satisfaction. Treatment effects were estimated with linear mixed models for the primary outcomes. We used logistic regression to identify differences in the secondary outcomes and explore for predictors of treatment satisfaction. Results. One hundred eighty three participants (chiropractic, n = 92; sham, n = 91) were recruited and included in the analyses. Participants receiving chiropractic therapy reported greater improvements in pain (mean difference, 95% confidence interval [CI] = 0.5 [0.1–0.9]), physical function (mean difference [95% CI] = 2.1 [0.3–4.0]), and were more likely to experience global improvement (48% vs. 24%, P = 0.01) and treatment satisfaction (78% vs. 56%, P < 0.01). There was no between-group difference in achieving a minimally acceptable outcome (34% sham vs. 29% chiropractic, P = 0.42). Awareness of treatment assignment and achieving minimally important improvement in pain intensity were associated with chiropractic treatment satisfaction. From the *School of Health Professions; †School of Psychology and Exercise Science, Murdoch University, Murdoch, Australia; and ‡School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada. Acknowledgment date: July 3, 2013. Revision date: August 14, 2013. Acceptance date: August 16, 2013. The manuscript submitted does not contain information about medical device(s)/drug(s). Chiropractors Registration Board of Victoria grant funds were received in support of this work. Relevant financial activities outside the submitted work: board membership, grants, consultancy, payment for development of educational presentations. Address correspondence and reprint requests to Bruce Walker, DC, MPH, DrPH, School of Health Professions, Murdoch University, 90 South St Murdoch, Murdoch, Australia; E-mail: bruce.walker@murdoch.edu.au A ccording to the 2010 Global Burden of Disease study, musculoskeletal disorders were the second leading cause of disability throughout the world. 1 In terms of individual disorders, the 2 most common forms of spinal pain, low back pain and neck pain, ranked respectively as the lead- ing and fourth leading cause of disability-adjusted life years. 1 This level of disability results in a substantial socioeconomic burden in both direct medical costs and indirect costs such as work absence and decreased productivity. 1–4 Hence, effective management of spinal pain is an important issue for patients, clinicians, and health care policy makers. In high-income countries chiropractic treatment is widely used for spinal pain. 3,5 However, recent systematic reviews have reported that small effect sizes of treatment and meth- odological limitations in published studies raise uncertainty about the value of chiropractic treatment. 6–9 A primary limita- tion of previous studies is the lack of randomized controlled trials comparing the effects of chiropractic treatment to inert interventions for spinal pain. 6–9 Accordingly, our primary aim was to examine the compara- tive effectiveness of a brief chiropractic intervention compared with sham treatment for participants with spinal pain. The secondary aim was to explore the clinical and demographic variables associated with treatment satisfaction. MATERIALS AND METHODS Study Design In this article, we report the secondary analysis of a 2-arm parallel-group randomized trial that compared the effective- ness of usual chiropractic treatment to a sham intervention. The primary analysis examined the occurrence of adverse events and this has been published elsewhere. 10 The protocol for this trial was published and the trial was registered Conclusion. Short-term chiropractic treatment was superior to sham; however, treatment effects were not clinically important. Awareness of treatment assignment and clinically important reductions in pain were associated with chiropractic treatment satisfaction. Key words: back pain, neck pain, effectiveness, chiropractic, manipulation, spinal, randomized controlled trial, clinical trial. Level of Evidence: 2 Spine 2013;38:2071–2078 Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.