Multidisciplinary integrative care versus chiropractic care for low back pain: a randomized clinical trial

Gert Bronfort, Michele Maiers, Craig Schulz, Brent Leininger, Kristine Westrom, Greg Angstman, Roni Evans

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Low back pain (LBP) is influenced by interrelated biological, psychological, and social factors, however current back pain management is largely dominated by one-size fits all unimodal treatments. Team based models with multiple provider types from complementary professional disciplines is one way of integrating therapies to address patients’ needs more comprehensively. Methods: This parallel group randomized clinical trial conducted from May 2007 to August 2010 aimed to evaluate the relative clinical effectiveness of 12 weeks of monodisciplinary chiropractic care (CC), versus multidisciplinary integrative care (IC), for adults with sub-acute and chronic LBP. The primary outcome was pain intensity and secondary outcomes were disability, improvement, medication use, quality of life, satisfaction, frequency of symptoms, missed work or reduced activities days, fear avoidance beliefs, self-efficacy, pain coping strategies and kinesiophobia measured at baseline and 4, 12, 26 and 52 weeks. Linear mixed models were used to analyze outcomes. Results: 201 participants were enrolled. The largest reductions in pain intensity occurred at the end of treatment and were 43% for CC and 47% for IC. The primary analysis found IC to be significantly superior to CC over the 1-year period (P = 0.02). The long-term profile for pain intensity which included data from weeks 4 through 52, showed a significant advantage of 0.5 for IC over CC (95% CI 0.1 to 0.9; P = 0.02; 0 to 10 scale). The short-term profile (weeks 4 to 12) favored IC by 0.4, but was not statistically significant (95% CI − 0.02 to 0.9; P = 0.06). There was also a significant advantage over the long term for IC in some secondary measures (disability, improvement, satisfaction and low back symptom frequency), but not for others (medication use, quality of life, leg symptom frequency, fear avoidance beliefs, self-efficacy, active pain coping, and kinesiophobia). Importantly, no serious adverse events resulted from either of the interventions. Conclusions: Participants in the IC group tended to have better outcomes than the CC group, however the magnitude of the group differences was relatively small. Given the resources required to successfully implement multidisciplinary integrative care teams, they may not be worthwhile, compared to monodisciplinary approaches like chiropractic care, for treating LBP. Trial registration NCT00567333.

Original languageEnglish (US)
Article number10
JournalChiropractic and Manual Therapies
Issue number1
StatePublished - Dec 2022

Bibliographical note

Funding Information:
Ethical approval for the study was provided by the Institutional Review Boards at Northwestern Health Sciences University #1-32-10-06 and the Minneapolis Medical Research Foundation # 07-2785. All participants provided written informed consent to participate.

Funding Information:
Research reported in this publication was supported by the Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), Bureau of Health Professions (BHPr), Division of Medicine and Dentistry (DMD) under award number R18HP07639. Efforts of Dr. Leininger and Dr. Schulz were also supported in part by the National Center For Complementary & Integrative Health of the National Institutes of Health (NIH) under Award Number K01AT008965 and KL2TR002492-02S1. The content is solely the responsibility of the authors and does not necessarily represent the official views of HHS, HRSA, BHPr, DMD or the NIH.

Publisher Copyright:
© 2022, The Author(s).


  • Back pain
  • Chiropractic
  • Clinical trial
  • Integrative medicine
  • Multidisciplinary


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