Nonpharmacologic Back Pain Treatment Use and Associated Patient Reported Outcomes in US-Based Integrative Medicine Clinics.

BACKGROUND

The integrative medicine (IM) clinic is an innovative care model that may increase access to guideline-concordant nonpharmacologic treatment use in healthcare delivery systems for prevalent conditions such as low back pain (LBP).

OBJECTIVE

To describe the use and effectiveness of IM services for LBP in IM clinics.

RESEARCH

DESIGN

Prospective cohort study.

SUBJECTS: Adult patients with LBP enrolled at seventeen IM clinics.

MEASURES: Patterns of IM service use were assessed over 12 months. Changes in clinical outcomes were assessed between index visit and 12-month follow-up using linear mixed-effects models. Primary (pain interference, physical function) and secondary (pain intensity, anxiety, depression, fatigue, sleep disturbance, social participation) outcomes were obtained from the PROMIS-29 instrument.

RESULTS

We identified 660 participants with LBP (mean age = 51.6 years, 75% female). Over the 12-month study period, common IM services were IM consults (56%), acupuncture (44%), chiropractic care (24%), physical therapy (19%), and massage (17%). Over two-thirds (70%) of participants received at least one guideline-concordant nonpharmacologic treatment. Participants with follow-up outcome data (n = 443, 67%) reported a modest reduction in pain interference with life activities in the short- and long-term (2-month mean difference [MD] = -1.47, 95%CI = -2.98, -0.64; 12-month MD = -1.98, 95%CI = -3.12, -0.88). By contrast, improvements in physical function were not statistically or clinically significant (2-month MD = 0.37, 95%CI = -0.28, 1.01; 12-month MD = 0.69, 95%CI = -0.31, 1.69). At 12 months, small improvements were observed on all secondary outcomes (pain intensity, anxiety, depression, and social participation) except fatigue and sleep disturbance.

CONCLUSIONS

Most patients with LBP receiving care at IM clinics received at least one guideline-recommended nonpharmacologic treatment. However, improvements on clinical outcomes were relatively small. Additional multi-site studies are needed to explore the optimal implementation approach.