What do patients value about spinal manipulation and home exercise for back-related leg pain? A qualitative study within a controlled clinical trial

Michele Maiers, Maria A. Hondras, Stacie A. Salsbury, Gert Bronfort, Roni Evans

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background Patient perceptions may influence the effectiveness and utilization of healthcare interventions, particularly for complex health conditions such as sciatica or back-related leg pain (BRLP). Objectives To explore BRLP patients’ perceptions of spinal manipulative therapy (SMT) and home exercise with advice (HEA). Design Qualitative study in a controlled clinical trial. Method Semi-structured interviews conducted after 12 weeks of treatment asked participants about satisfaction with care and whether treatment was worthwhile. An interdisciplinary research team conducted content analysis using qualitative data analysis software to identify and summarize themes. Results Of 192 trial participants, 174 (91%) completed interviews (66% female, age 57.0 ± 11.5 years). Participants identified interactions with providers and staff, perceived treatment effects, and information as key contributors to both their satisfaction and the worthwhile nature of treatment. HEA was liked for its convenience and ability to foster an exercise habit. SMT was liked for specific aspects of the modality (e.g. manipulation, stretching) and provider competency. Most participants reported no dislikes for SMT or HEA, but some noted the dose/time commitment for SMT and discipline of HEA as least liked aspects of the interventions. Conclusions The quality of patient–provider interactions, perceived treatment effects, and information sharing influenced BRLP patients’ satisfaction with care. Qualitative research describing patients’ preferences can facilitate translation of study findings into practice and allow clinicians to tailor treatments to facilitate compliance and satisfaction with care.

Original languageEnglish (US)
Pages (from-to)183-191
Number of pages9
JournalManual Therapy
StatePublished - Dec 1 2016

Bibliographical note

Funding Information:
This project was supported by funds from the U.S. 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 grant number R18HP07638 , Chiropractic and Self-Care For Back-Related Leg Pain. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the U.S. government, HHS, HRSA, BHPr or the DMD.

Publisher Copyright:
© 2016 Elsevier Ltd


  • Exercise
  • Satisfaction
  • Sciatica
  • Spinal manipulation


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