Musculoskeletal Medicine and PainORIGINAL ARTICLE
Abstract
Context: Osteopathic medical care has been associated with better long-term outcomes in an intention-to-treat analysis of data from a retrospective cohort study involving chronic low back pain (CLBP). The beneficial outcomes attributable to osteopathic medical care were mediated by physician empathy and osteopathic manipulative treatment (OMT) in the subset of patients who consistently utilized osteopathic physicians compared with those who utilized allopathic physicians.
Objectives: This study utilized data from the previously reported study to conduct a per-protocol analysis to determine the outcomes of osteopathic medical care utilizing a pragmatic research design in which patients consistently received osteopathic or allopathic medical care during long-term follow-up.
Methods: A retrospective cohort study was conducted utilizing patients with CLBP selected from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from September 2016 through August 2024. Patients were followed at quarterly encounters after enrollment to determine whether they consistently received care for low back pain from either osteopathic or allopathic physicians. Data pertaining to pain, function, pain impact, health-related quality of life (HRQOL), and the frequency of chronic widespread pain (CWP) and CLBP recovery were measured at quarterly encounters for up to 36 months. Both unadjusted and adjusted results were measured over time. The latter were computed utilizing generalized estimating equations (GEEs) with covariates including sociodemographic and clinical characteristics. The clinical relevance of treatment-group differences was measured utilizing Cohen’s d statistic.
Results: There were 1,078 patients in the study, including 132 (12.2 %) and 946 (87.8 %) treated by osteopathic and allopathic physicians, respectively. A total of 5,836 encounters were completed over 36 months, including 818 (14.0 %) and 5,018 (86.0 %) in the osteopathic and allopathic medical care groups, respectively. The adjusted means (95 % confidence intervals [CIs]) for patients treated by osteopathic vs. allopathic physicians were 6.0 (5.6–6.3) vs. 6.4 (6.2–6.7) for low back pain intensity (p=0.002); 13.5 (12.2–14.9) vs. 15.3 (14.4–16.2) for back-related disability (p<0.001); 30.2 (28.3–32.0) vs. 31.8 (30.7–33.0) for pain impact (p=0.03); 38.6 (37.3–40.0) vs. 37.2 (36.4–38.0) for physical function (p=0.01); 52.7 (50.9–54.5) vs. 54.3 (53.1–55.6) for depression (p=0.02); and 56.4 (54.9–58.0) vs. 58.0 (56.9–59.1) for sleep disturbance (p=0.01). These results all favored osteopathic medical care and the results for low back pain intensity (Cohen’s d=0.23), back-related disability (Cohen’s d=0.27), and physical function (Cohen’s d=0.21) exceeded the threshold for clinical relevance. Osteopathic medical care was also associated with greater CLBP recovery (odds ratio [OR], 2.07; 95 % CI, 1.28–3.35; p=0.003), although recovery was infrequently reported during follow-up.
Conclusions: This per-protocol analysis found better outcomes in pain, function, pain impact, and HRQOL, including physical function, depression, and sleep disturbance, among patients treated by osteopathic physicians compared with allopathic physicians over 36 months of follow-up after adjusting for sociodemographic and clinical characteristics. The findings for low back pain intensity, back-related disability, and physical function were also clinically relevant. Osteopathic medical care was associated with greater recovery from CLBP, although recovery was infrequently reported.