Evidence map›Paper›PMID 40001085›Full record

Trial reportBMC musculoskeletal disorders2025

Effectiveness and cost-effectiveness of chiropractic and physiotherapy for chronic low back pain: a multicenter RCT in Sweden.

Filip Gedin, Martin Skeppholm, Vibeke Sparring, Niklas Zethraeus

Abstract readMulticenter StudyRandomized Controlled TrialPragmatic Clinical Trial
In one paragraph

Trial report in BMC musculoskeletal disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Filip GedinDepartment of Learning, Informatics, Karolinska Institute, Management and Ethics (LIME), Nobels väg 9, D3, Stockholm, 171 77, Sweden. Filip.Gedin@ki.se.
Martin SkeppholmDepartment of Learning, Informatics, Karolinska Institute, Management and Ethics (LIME), Nobels väg 9, D3, Stockholm, 171 77, Sweden.
Vibeke SparringDepartment of Learning, Informatics, Karolinska Institute, Management and Ethics (LIME), Nobels väg 9, D3, Stockholm, 171 77, Sweden.
Niklas ZethraeusDepartment of Learning, Informatics, Karolinska Institute, Management and Ethics (LIME), Nobels väg 9, D3, Stockholm, 171 77, Sweden.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate the effectiveness and cost-effectiveness of physiotherapy, chiropractic care, and the combination of physiotherapy and chiropractic care compared with information and advice for the treatment of patients with nonspecific chronic low-back pain (CLBP) in Sweden.

designA multicentre pragmatic randomized controlled trial.

settingTen primary care rehabilitation units in Sweden.

participantsEighty-eight participants with nonspecific CLBP.

interventionsThe participants were randomly assigned to receive physiotherapy, chiropractic care, combination treatment, or information and advice.

main outcome measuresThis study measured the Oswestry Disability Index (ODI), health-related quality of life (HRQoL), quality-adjusted life-years (QALYs), working status, and costs.

resultsThe study revealed no statistically significant differences in any of the outcome measures when physiotherapy, chiropractic care, and combination treatment with information and advice were compared (p > 0.05). The ODI changes between baseline and the 6-month follow-up ranged from 6.13 to 12.56 across the treatment groups, indicating reduced disability in all groups. Compared with the other treatment options, the combination treatment resulted in the greatest QALY gain (0.418) and lowest cost (SEK 3,081).

conclusionCompared with alternative standalone treatment options, the combination treatment strategy resulted in greater QALY gain and lower costs from a heath care perspective. Although the study did not detect statistically significant differences in outcomes or costs among the treatment options, the combination treatment showed promising potential for cost-effectiveness. Given the small sample size and low statistical power of the study, further clinical trials with fewer treatment arms and a focus on the combination group are warranted to confirm these findings. The insights gained from this study are important for informing the design and conduct of future clinical studies investigating the effectiveness, costs and cost-effectiveness of treatments for CLBP.

trial registrationThe study is registered in the ISRCTN registry (2017-02-20: ISRCTN15830360).

Indexed as

Chronic PainLow Back PainManipulation, ChiropracticPhysical Therapy ModalitiesAdultAgedCombined Modality TherapyCost-Benefit AnalysisDisability EvaluationFemaleHealth Care CostsHumansMaleMiddle AgedQuality-Adjusted Life YearsQuality of LifeChiropractic careCost-effectivenessLow back painPhysiotherapyPrimary health care

Identifiers

PMID40001085
PMCPMC11853996

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.