Exploring the Definition of Acute Low Back Pain: A Prospective Observational Cohort Study Comparing Outcomes of Chiropractic Patients With 0-2, 2-4, and 4-12 Weeks of Symptoms

Abstract Objective The purpose of this study was to compare improvement rates in patients with low back pain (LBP) undergoing chiropractic treatment with 0-2 weeks vs 2-4 and 4-12 weeks of symptoms. Methods This was a prospective cohort outcome study with 1-year follow-up including adult acute (symptoms 0-4 weeks) LBP patients. The numerical rating scale for pain (NRS) and Oswestry questionnaire were completed at baseline, 1 week, 1 month, and 3 months after starting treatment. The Patient Global Impression of Change (PGIC) scale was completed at all follow-up time points. At 6 months and 1 year, NRS and PGIC data were collected. The proportion of patients reporting relevant “improvement” (PGIC scale) was compared between patients having 0-2 and 2-4 weeks of symptoms using the χ2 test at all data collection time points. The unpaired t test compared NRS and Oswestry change scores between these 2 groups. Results Patients with 0-2 weeks of symptoms were significantly more likely to “improve” at 1 week, 1 month, and 6 months compared with those with 2-4 weeks of symptoms ( P < .015). Patients with 0-2 weeks of symptoms reported significantly higher NRS and Oswestry change scores at all data collection time points. Outcomes for patients with 2-4 weeks of symptoms were similar to patients having 4-12 weeks of symptoms. Conclusion The time period 0-4 weeks as the definition of “acute” should be challenged. Patients with 2-4 weeks of symptoms had outcomes similar to patients with subacute (4-12 weeks) symptoms and not with patients reporting 0-2 weeks of symptoms.