Heterogeneity in effectiveness of conservative complementary and alternative medicine treatment for lumbar disc herniation: A latent trajectory analysis

Objective Understanding the heterogeneity in treatment effectiveness is essential for developing personalized management strategies in clinical practice. We aimed to analyze the heterogeneity of outcomes related to pain, disability, and quality of life in patients undergoing conservative complementary and alternative medicine-based treatment for lumbar disc herniation. Design This is a prospective observational study. Setting and subjects We included 996 adults diagnosed with lumbar disc herniation confirmed by magnetic resonance imaging findings within 3 years, experiencing radiating pain with a Numerical Rating Scale (NRS) score ≥5 for low back or radiating pain. Patients were recruited in Korean Medicine hospitals in four sites. Conservative complementary and alternative medicine-based treatments included acupuncture, moxibustion, cupping, Chuna manual therapy, and herbal medicine. Baseline was measured and the outcomes were followed-up at 14 days, discharge, and 6 months post-admission. Methods The main outcomes were pain (NRS), disability (Oswestry Disability Index [ODI]), and quality of life (EuroQol-5D-5L [EQ-5D-5L]). Latent trajectory analysis classified outcome groups. Baseline characteristics that is associated with prognosis were explored using logistic regression. Results A total of 732 patients (73.5%) completed the 6-month follow-up. Patients were classified into two trajectory groups for each outcome. For back pain (NRS), 900 (90.4%) were in the Improved group, while 96 (9.6%) experienced relapse; leg pain showed a similar pattern. ODI classified patients into Improved (n = 850, 85.3%) and Less-Improved (n = 146, 14.7%) groups. EQ-5D-5L divided patients into Improved (n = 415, 41.7%) and Highly Improved (n = 581, 58.3%) groups. Higher baseline scores for the respective outcomes were associated with a worse prognosis. Conclusion Distinct outcome trajectories highlight the heterogeneity in patient responses to conservative complementary and alternative medicine-based treatments.