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Chiropractic
Effectiveness
During the past 20 years, over 100
studies of the effectiveness of chiropractic care, both alone and
in combination with other treatments, have been conducted by
reputable researchers. The studies have included clinical trials,
research of medical records, consumer surveys, and chiropractic
surveys.
The research has shown that chiropractic care is either more
effective or as effective as comparable pharmaceutical and
surgical treatments for back and neck pains and for certain types
of headaches.
Perhaps of even more importance, the
research has shown that chiropractic care is significantly safer
than comparable pharmaceutical and surgical treatments, producing
far fewer (about 4,000 times fewer, according to one study)
negative side effects such as chronic pain, disability, or death.
In 1993, Texas Back Institute, the
largest freestanding spine specialty clinic in the United States,
added doctors of chiropractic to its professional staff after
careful review of scientific evidence and visiting chiropractic
colleges.
Florida Workers' Compensation Study
A 1998 study of 10,652 Florida
workers' compensation cases was conducted by Steve Wolk, Ph.D.,
and reported by the Foundation for Chiropractic Education and
Research. It was concluded that "a claimant with a back-related
injury, when initially treated by a chiropractor versus a medical
doctor, is less likely to become temporarily disabled, or if
disabled, remains disabled for a shorter period of time; and
claimants treated by medical doctors were hospitalized at a much
higher rate than claimants treated by chiropractors."
Washington HMO Study
In 1989, a survey administered by
Daniel C. Cherkin, Ph.D., and Frederick A. MacCornack, Ph.D.,
concluded that patients receiving care from health maintenance
organizations (HMOs) within the state of Washington were three
times as likely to report satisfaction with care from
chiropractors as they were with care from other physicians. The
patients were also more likely to believe that their chiropractor
was concerned about them.
Utah Workers' Compensation Study
A workers' compensation study
conducted in Utah by Kelly B. Jarvis, D.C., Reed B. Phillips,
D.C., Ph.D., and Elliot K. Morris, JD, MBA, compared the cost of
chiropractic care to the costs of medical care for conditions with
identical diagnostic codes. Results were reported in the 1991
Journal of Occupational Medicine. The study indicated that costs
were significantly higher for medical claims than for chiropractic
claims; in addition, the number of work days lost was nearly ten
times higher for those who received medical care instead of
chiropractic care.
Patient Disability Comparison
A 1992 article in the Journal of
Family Practice reported a study by D.C. Cherkin, Ph.D., which
compared patients of family physicians and of chiropractors. The
article stated "the number of days of disability for patients seen
by family physicians was significantly higher (mean 39.7) than for
patients managed by chiropractors (mean 10.8)." A related
editorial in the same issue referred to risks of complications
from lumbar manipulation as being "very low."
Oregon Workers' Compensation
A 1991 report on a workers'
compensation study conducted in Oregon by Joanne Nyiendo, Ph.D.,
concluded that the median time loss days (per case) for comparable
injuries was 9.0 for patients receiving treatment by a doctor of
chiropractic and 11.5 for treatment by a medical doctor.
Stano Cost Comparison Study
A study by Miron Stano, Ph.D.,
reported in June 1993 Journal of Manipulative and Physiological
Therapeutics involved 395,641 patients with neuromusculoskeletal
conditions. Results over a two-year period showed that patients
who received chiropractic care incurred significantly lower health
care costs than did patients treated solely by medical or
osteopathic physicians.
Saskatchewan Clinical Research
Following a 1993 study, researchers J.
David Cassidy, D.C., Hayno Thiel, D.C., M.S., and W. Kirkaldy
Willis, M.D., of the Back Pain Clinic at the Royal University
Hospital in Saskatchewan concluded that "the treatment of lumbar
intervertebral disk herniation by side posture manipulation is
both safe and effective."
Wight Study on Recurring Headaches
A 1978 study conducted by J.S. Wight,
D.C., and reported in the ACA Journal of Chiropractic, indicated
that 74.6% of patients with recurring headaches, including
migraines, were either cured or experienced reduced headache
symptomatology after receiving chiropractic manipulation.
1991 Gallup Poll
A 1991 demographic poll conducted by
the Gallup Organization revealed that 90% of chiropractic patients
felt their treatment was effective; more than 80% were satisfied
with that treatment; and nearly 75% felt most of their
expectations had been met during their chiropractic visits.
1990 British Medical Journal Report
A study conducted by T.W. Meade, a
medical doctor, and reported in the June 2, 1990, British Medical
Journal concluded after two years of patient monitoring, "for
patients with low-back pain in whom manipulation is not
contraindicated, chiropractic almost certainly confers worthwhile,
long-tem benefit in comparison with hospital outpatient
management."
Virginia Comparative Study
A 1992 study conducted by L.G.
Schifrin, Ph.D., provided an economic assessment of mandated
health insurance coverage for chiropractic treatment within the
Commonwealth of Virginia. As reported by the College of William
and Mary, and the Medical College of Virginia, the study indicated
that chiropractic provides therapeutic benefits at economical
costs. The report also recommended that chiropractic be a widely
available form of health care.
1992 America Health Policy Report
Journal of American Health Policy,
stated that, "chiropractic users tend to have substantially lower
total health care costs," and "chiropractic care reduces the use
of both physician and hospital care."
1985 University of Saskatchewan Study
In 1985, the University of
Saskatchewan conducted a study of 283 patients "who had not
responded to previous conservative or operative treatment" and who
were initially classified as totally disabled. The study revealed
that "81% became symptom free or achieved a state of mild
intermittent pain with no work restrictions" after daily spinal
manipulations were administered.
Manipulation vs. Flexion/Extension Exercises in Low Back Pain
Patients
The authors concluded that,
"manipulative intervention followed by a general lumbar range of
motion regimen (as opposed to an extension- or flexion- oriented
program without manipulation) may be the key to rapid improvement
in patients with low back symptoms…"
(Physical Therapy, December 1994, Vol.
74, No.12.)
Swedish Study
A study conducted in Sweden has
determined that 1 in 4 chiropractic patients experiences some form
of "positive nonmusculoskeletal side effect" after spinal
manipulative therapy. In addition, the percentage of patients who
experience positive side effects increases with the number of
spinal regions adjusted. This study was done with 1,504 valid
patient questionaires. At least one positive side effect was
reported by 23% of the respondents. Most felt benefits such as
easier to breathe, improved digestive function, circulation,
clearer and sharper vision, changes in heart rhythm and blood
pressure. The authors of this research study believe that these
results are exciting and additional research is needed.
(Journal of Manipulative Physio
Therapy 1999;22:559-64)
Chronic Headache Studies
There is mounting evidence of the
effectiveness of manipulation in the treatment of patients with
CHRONIC HEADACHES. Recent research has looked at the role that
chiropractic treatment can play in management of patients with
chronic headaches:
In the first study reviewed here, 218
patients diagnosed with chronic migraine were randomized to
receive either cervical manipulation, amitriptyline (a tricyclic
antidepressant that is commonly used for migraine prophylaxis) or
a combination of both manipulation and amitriptyline. The results
showed that there were clinically important improvements in all
three groups over time. During the treatment phase, there were no
statistically significant differences in the three groups, but a
difference was seen in the follow up period. They found that there
was a statistically significant difference favoring the cervical
manipulation group compared to the others.
The side effects were much greater in the amitriptyline group,
with 58% reporting side effects and 10% having to drop out because
of them. There were minimal and mild side effects of manipulation,
and no one had to drop out because of them.
The second study is a prospective,
uncontrolled clinical trial of twelve months duration. The trial
consisted of 3 stages: a two month pre-treatment observation
stage, a two month treatment stage, and a two month post-treatment
follow up stage. The initial 32 participants showed statistically
significant improvement in migraine frequency, intensity,
disability and medication use, when compared to initial baseline
levels. At six month follow-up, there was continued statistically
significant improvement.
The third study was a randomized,
controlled trial (RCT) performed by the same group as the second.
Here, 83 subjects were randomized to receive either manipulation
over 2 months, with a maximum of 16 treatments, or detuned
interferential over the same time period. They found that the
average response in the treatment group showed statistically
significant improvement in frequency, duration and medication use
as compared to the control group. They express the results in
other terms by saying that 22% of the treatment group reported
greater than 90% reduction of their migraine and a further 49%
reported significant improvement in the morbidity of each episode.
Only 4.1% of participants reported that their migraine episodes
were worse after the 2 months of treatment, but this was not
sustained at the 2 month follow up.
(Nelson CF, Bronfort G, Evans R et al:
The efficacy of spinal manipulation, amitriptyline and the
combination of both therapies for the prophylaxis of migraine
headache. J Manipulative Physiol Ther 1998; 21(8):511-519)
(Tuchin PJ. A twelve month clinical
trial of chiropractic spinal manipulative therapy for migraine.
College Osteopath Chiro College J. 1999;8(2))
(Tuchin PJ, Pollard HJ, Bonello R. A
randomized controlled trial of chiropractic spinal manipulative
therapy for migraine. J Manipulative Physiol Ther
2000;23(2):91-95)
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