Sciatica

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.

Objective: To assess the feasibility of recruiting sciatica patients and to evaluate their compliance in preparation for a full-scale randomized clinical trial. We also aimed to determine the responsiveness of key outcome measures.

Methods: Thirty-two subjects were randomly assigned to spinal manipulation (n=11), epidural steroid injections (n=11), or self-care education (n=10). No between-group comparisons were planned because of the small sample size.

Results: At week 12 (the end of the treatment phase), the outcome measures indicating the most improvement/change were the Oswestry disability score (mean, 22.9; SD, 19.9; effect size [ES], 1.8), leg pain severity (mean, 2.9; SD, 1.7; ES, 1.7), and if the symptoms were bothersome (mean, 25.2; SD, 16.0; ES, 1.6). Twenty-four patients were either “very satisfied” or “completely satisfied,” and 22 of 32 patients reported 75% or 100% improvement. After 52 weeks, the outcome measure showing the most improvement/change was leg pain severity (mean, 2.3; SD, 2.6; ES, 1.35), followed by the Oswestry disability score (mean, 15.6; SD, 20; ES, 1.2) and if symptoms were bothersome (mean, 18.1; SD, 22.6; ES, 1.1). Eighteen patients were either “very satisfied” or “completely satisfied,” and 15 of 32 patients reported 75% or 100% improvement.

Conclusions: The results of this pilot study suggest that it is feasible to recruit subacute and chronic sciatica patients and to obtain their compliance for a full-scale randomized clinical.