摘要：Objectives . This study examined the difference in satisfaction between patients assigned to chiropractic vs medical care for treatment of low back pain in a managed care organization. Methods . Satisfaction scores (on a 10–50 scale) after 4 weeks of follow-up were compared among 672 patients randomized to receive medical or chiropractic care. Results . The mean satisfaction score for chiropractic patients was greater than the score for medical patients (crude difference = 5.5; 95% confidence interval = 4.5, 6.5). Self-care advice and explanation of treatment predicted satisfaction and reduced the estimated difference between chiropractic and medical patients’ satisfaction. Conclusions . Communication of advice and information to patients with low back pain increases their satisfaction with providers and accounts for much of the difference between chiropractic and medical patients’ satisfaction. Patient satisfaction is an important component of evaluating care for low back pain, especially because objectively measurable treatment outcomes are largely absent. Among low back pain patients in the United States, about one third as many go to chiropractors as to medical doctors. 1 In recent decades, the formerly skeptical physician community has been reexamining the chiropractor’s ability to treat low back pain and to achieve high patient satisfaction. 2, 3 In 3 earlier randomized clinical trials, investigators compared patient satisfaction with spinal manipulation vs medical care or physical therapy for low back pain. The first study concluded that patients were more satisfied with chiropractic care than with physical therapy after 6 weeks. 4 In the second, patients receiving chiropractic manipulation and patients receiving the McKenzie method of physical therapy had similar levels of satisfaction after 4 weeks. 5 In the third study, patients receiving osteopathic manipulation and patients receiving standard medical therapy (with similar numbers of visits) had similar levels of satisfaction after 12 weeks. 6 Results from observational studies suggest that back pain patients are more satisfied with chiropractic care than with medical care. 7– 9 In meta-analyses of clinical outcomes of spinal manipulation for back pain, some researchers have concluded that spinal manipulation is more effective than a placebo, 2 whereas others have argued that no conclusion can be drawn from existing evidence. 10 Predictors of satisfaction with chiropractic care have included total duration of treatment, number of visits, and patient’s perception of improvement. 11 In more recent studies, predictors of satisfaction with medical therapy for low back pain have included posttreatment pain, disability, and employment status 12 ; coping styles; and baseline expectations of effectiveness. 13 For these medical patients, the change in pain and disability over the course of treatment did not predict satisfaction. 12, 13 Results from previous studies suggest that chiropractors’ communication styles and beliefs differ from those of physicians. Chiropractors believe that treatment can prevent continuation or recurrence of low back pain 14 and that the success of treatment depends on the patient’s understanding of low back pain and its treatment. 15, 16 The extent to which differences in giving advice might account for differences in patient satisfaction has yet to be explored. We know from studies of primary care physicians that providing information 17 and encouraging patient participation in care 18 lead to greater patient satisfaction. Thus, in the context of our randomized trial of low back pain treatment, we addressed 3 questions: (1) whether chiropractic patients are more satisfied than medical patients with their back care; (2) whether chiropractors communicate more advice and information to their patients than do medical providers; and (3) whether such differences in communication account for differences in patient satisfaction between chiropractic and medical patients.
