{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T16:49:19Z","timestamp":1769186959847,"version":"3.49.0"},"reference-count":14,"publisher":"BMJ","issue":"6737","license":[{"start":{"date-parts":[[1990,6,2]],"date-time":"1990-06-02T00:00:00Z","timestamp":644284800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1990,6,2]]},"abstract":"<jats:p>OBJECTIVE--To compare chiropractic and hospital outpatient treatment for managing low back pain of mechanical origin. DESIGN--Randomised controlled trial. Allocation to chiropractic or hospital management by minimisation to establish groups for analysis of results according to initial referral clinic, length of current episode, history, and severity of back pain. Patients were followed up for up two years. SETTING--Chiropractic and hospital outpatient clinics in 11 centres. PATIENTS--741 Patients aged 18-65 who had no contraindications to manipulation and who had not been treated within the past month. INTERVENTIONS--Treatment at the discretion of the chiropractors, who used chiropractic manipulation in most patients, or of the hospital staff, who most commonly used Maitland mobilisation or manipulation, or both. MAIN OUTCOME MEASURES--Changes in the score on the Oswestry pain disability questionnaire and in the results of tests of straight leg raising and lumbar flexion. RESULTS--Chiropractic treatment was more effective than hospital outpatient management, mainly for patients with chronic or severe back pain. A benefit of about 7% points on the Oswestry scale was seen at two years. The benefit of chiropractic treatment became more evident throughout the follow up period. Secondary outcome measures also showed that chiropractic was more beneficial. CONCLUSIONS--For patients with low back pain in whom manipulation is not contraindicated chiropractic almost certainly confers worthwhile, long term benefit in comparison with hospital outpatient management. The benefit is seen mainly in those with chronic or severe pain. Introducing chiropractic into NHS practice should be considered.<\/jats:p>","DOI":"10.1136\/bmj.300.6737.1431","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T15:19:55Z","timestamp":1238685595000},"page":"1431-1437","source":"Crossref","is-referenced-by-count":326,"title":["Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment."],"prefix":"10.1136","volume":"300","author":[{"given":"T W","family":"Meade","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Dyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W","family":"Browne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J","family":"Townsend","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A O","family":"Frank","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1990,6,2]]},"reference":[{"key":"ref_1","article-title":"Alternative therapy. Report of the board of science and education","author":"British Medical Association","unstructured":"British Medical Association. Alternative therapy. Report of the board of science and education. Spalding: Chamelcori Press, 1986:77."},{"key":"ref_2","article-title":"Security Working Group on Back Pain. Report to secretare of state for social services","author":"Department of Health and Social","year":"1979","unstructured":"Department of Health and Social Security Working Group on Back Pain. Report to secretare of state for social services. ILondon: HMSO, 1979."},{"issue":"297","key":"ref_3","first-page":"1567","article-title":"Trouble ahead for clinical trials","volume":"1988","author":"Smith, R.","unstructured":"Smith R. Trouble ahead for clinical trials. BrMedJ7 1988;297:1567.","journal-title":"BrMedJ7"},{"key":"ref_4","first-page":"41","article-title":"Spinal pain","volume-title":"diseases: physical, environmental and psychosocial management","author":"Frank, A.O.; Hills, J.E.","year":"1988","unstructured":"Frank AO, Hills JE. Spinal pain. In: Frank AO, Maguire GP, eds. Disabling diseases: physical, environmental and psychosocial management. Oxford: Heiiiemann Medical Books, 1988:41-73."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1136\/jech.40.1.12","article-title":"Comparison of chiropractic and hospital outpatient management of low back pain: a feasibility study","volume":"40","author":"Meade, T.W.; Browne, W.; Mellows, S.","year":"1986","unstructured":"Meade TW, Browne W, Mellows S, et al. Comparison of chiropractic and hospital outpatient management of low back pain: a feasibility study. J Epidemiol Community Health 1986;40:12-7.","journal-title":"J Epidemiol Community Health"},{"key":"ref_6","first-page":"271","article-title":"The Oswestry low back pain disability questionnaire","volume":"66","author":"Fairbank, J.; Davies, J.; Coupar, J.; O'Brien, J.P.","year":"1980","unstructured":"Fairbank J, Davies J, Coupar J, O'Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy 1980;66:271-3.","journal-title":"Physiotherapy"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1093\/rheumatology\/14.2.115","article-title":"Inclinometer for measuring straight-leg raising","volume":"14","author":"Zinovieff, A.; Harborow, P.R.H.","year":"1975","unstructured":"Zinovieff A, Harborow PRH. Inclinometer for measuring straight-leg raising. Rheumatology and Rehabilitation, 1975;14: 115.","journal-title":"Rheumatology and Rehabilitation"},{"issue":"28","key":"ref_8","first-page":"584","article-title":"Measurement of back movement","volume":"1969","author":"McCray, I.F.; Wright, V.","unstructured":"McCray IF, Wright V. Measurement of back movement. Annals ofRheumatic Diseases 1969;28:584.","journal-title":"Annals ofRheumatic Diseases"},{"key":"ref_9","first-page":"10","article-title":"The detection of psychological abnormality in chronic low back pain using four simple scales","volume":"2","author":"Main, C.J.; Waddell, G.","year":"1984","unstructured":"Main CJ, Waddell G. The detection of psychological abnormality in chronic low back pain using four simple scales. Current Concepts in Pain 1984;2:10-5.","journal-title":"Current Concepts in Pain"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"103","DOI":"10.2307\/2529712","article-title":"Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial","volume":"31","author":"Simon, R.","year":"1975","unstructured":"Simon R. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics 1975;31:103-15.","journal-title":"Biometrics"},{"key":"ref_11","first-page":"821","article-title":"Acute lumbar strain: clinical signs and prognosis","volume":"222","author":"Glass, J.B.","year":"1979","unstructured":"Glass JB. Acute lumbar strain: clinical signs and prognosis. Practitioner 1979;222:821-5.","journal-title":"Practitioner"},{"key":"ref_12","article-title":"Epidemiology of back pain","volume-title":"7The lumbar spine and back pain","author":"Wood, P.H.N.; Badley, E.M.","year":"1980","unstructured":"Wood PHN, Badley EM. Epidemiology of back pain. In: Javson MIV, ed. 7The lumbar spine and back pain. 2nd ed. Tunbridge Wells: Pitman Medical, 1980.","edition":"2nd ed"},{"key":"ref_13","first-page":"1454","article-title":"A limited role for manipulation","volume":"293","author":"Jayson, M.I.V.","year":"1986","unstructured":"Jayson MIV. A limited role for manipulation. BrMedj 1986;293:1454-5.","journal-title":"BrMedj"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/S0307-742X(21)00284-8","article-title":"Clinical trials in low back pain","volume":"6","author":"Grahame, R.","year":"1980","unstructured":"Grahame R. Clinical trials in low back pain. 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