Heterogeneity in effectiveness of conservative complementary and alternative medicine treatment for lumbar disc herniation: a latent trajectory analysis.

OBJECTIVE

Understanding the heterogeneity in treatment effectiveness is essential for developing personalized management strategies in clinical practice. We aimed to analyze the heterogeneity of outcomes related to pain, disability, and quality of life in patients undergoing conservative complementary and alternative medicine-based treatment for lumbar disc herniation.

DESIGN

This is a prospective observational study.

SETTING AND SUBJECTS: We included 996 adults who had been diagnosed with lumbar disc herniation confirmed by magnetic resonance imaging findings within the prior 3 years and who had been experiencing radiating pain with a numeric rating scale (NRS) score ≥5 for low back or radiating pain. Patients were recruited in Korean Medicine hospitals at 4 sites. Conservative complementary and alternative medicine-based treatments included acupuncture, moxibustion, cupping, Chuna manual therapy, and herbal medicine. Baseline was measured, and the outcomes were followed up at 14 days, discharge, and 6 months after admission.

METHODS

The main outcomes were pain (NRS), disability (Oswestry Disability Index [ODI]), and quality of life (EuroQol-5D-5L [EQ-5D-5L]). Latent trajectory analysis classified outcome groups. Baseline characteristics that were associated with prognosis were explored via logistic regression.

RESULTS

A total of 732 patients (73.5%) completed the 6-month follow-up. Patients were classified into 2 trajectory groups for each outcome. For back pain (NRS), 900 (90.4%) were in the "Improved" group, whereas 96 (9.6%) experienced relapse; leg pain showed a similar pattern. ODI classified patients into "Improved" (n = 850, 85.3%) and "Less Improved" (n = 146, 14.7%) groups. EQ-5D-5L divided patients into "Improved" (n = 415, 41.7%) and "Highly Improved" (n = 581, 58.3%) groups. Higher baseline scores for the respective outcomes were associated with a worse prognosis.

CONCLUSION

Distinct outcome trajectories highlight the heterogeneity in patient responses to conservative complementary and alternative medicine-based treatments.

TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03750591; Clinical Research Information Service (CRIS) of Republic of Korea ID: KCT0003709.