Appendix 2 - Efficacy - Studies into Treatment Outcomes

Extensive research has been undertaken in the area of biomechanics. Research is progressing in the field of manipulative therapy. Chiropractic and Osteopathy have a significant clinical evidence base. Several large studies support the use of spinal manipulation.

The following are examples:

BMJ 2004 Dec 11;329 (7479):1377. Epub 2004 Nov 19.

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care.

BMJ 2004 Dec 11;329(7479):1381. Epub 2004 Nov 19.

United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care.

UK BEAM Trial Team.        http://www.ncbi.nlm.nih.gov/pubmed/15556954

Conclusions:

Spinal manipulation is a cost effective addition to "best care" for back pain in general practice. Manipulation alone probably gives better value for money than manipulation followed by exercise.

Effectiveness of Manual Therapies – The UK Evidence Report 

This review, by Gert Bronfort et al, was published in the journal Chiropractic & Osteopathy in 2010. Commentaries by Professor Scott Haldeman and Professor Martin Underwood accompany the report. In summary, the report demonstrates robust randomised controlled trial (RCT) evidence that the care offered by chiropractors is effective for a wide range of conditions including neck pain, pain associated with hip and knee osteoarthritis and some types of headache.

The Meade report (British Medical Journal, June 1990):

Quoting from the Meade study:

“There is economic support for the use of Chiropractic in low back pain, though the obvious clinical improvement in pain and disability attributable to Chiropractic treatment is in itself an adequate reason for considering the use of Chiropractic”.

The Meade report follow-up (BMJ, August 1995):

Results confirm findings of earlier study that subjects derived more benefit and long term satisfaction from Chiropractic treatment versus hospitalization.

The Manga Report.  August 1993

A Study to Examine the Effectiveness and Cost-Effectiveness of Chiropractic Management of Low-Back Pain by:

            1. Pran Manga, Ph.D.

            2. Douglas E. Angus, M.A.

            3. Costa Papadopoulos, MHA.

            4. William R. Swan, B.Comm.

The Ministry of Health, Government of Ontario solely funded this project.

Findings

F1. On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for LBP. Many medical therapies are of questionable validity or are clearly inadequate.

F2. There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low-back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic complications for LBP patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low-back pain.

F3.  There is an overwhelming body of evidence indicating that chiropractic management of low-back pain is more cost-effective than medical management. We reviewed numerous studies that range from very persuasive to convincing in support of this conclusion. The lack of any convincing argument or evidence to the contrary must be noted and is significant to us in forming our conclusions and recommendations. The evidence includes studies showing lower chiropractic costs for the same diagnosis and episodic need for care.

F4.  There would be highly significant cost savings if more management of LBP was transferred from medical physicians to chiropractors. There is good empirical evidence that patients are very satisfied with chiropractic management of LBP and considerably less satisfied with physician management.

F5. Patient satisfaction is an important health outcome indicator and adds further weight to the clinical and health economic results favouring chiropractic management of LBP.

F6. Despite official medical disapproval and economic disincentive to patients (higher private out-of-pocket cost), the use of chiropractic has grown steadily over the years. Chiropractors are now accepted as a legitimate healing profession by the public and an increasing number of medical physicians.

F7. In our view, the constellation of the evidence of:

 (a) the effectiveness and cost-effectiveness of chiropractic management of low-back pain.

 (b) the untested, questionable or harmful nature of many current medical therapies .

 (c) the economic efficiency of chiropractic care for low-back pain compared with medical care.

 (d) the safety of chiropractic care.

 (e) the higher satisfaction levels expressed by patients of  chiropractors, together offers an overwhelming case in favour of  much greater use of chiropractic services in the  management of low-back pain.

Utah Workman’s Compensation Study:

Jarvis KB, Phillips RB, and Morris EK, Journal of Occupational Medicine 1991 v 33:8 (pp 847-851).

“Cost per Case Compensation of Back Injury Claims of Chiropractic cf. Medical Management of Conditions with Identical Diagnostic Codes”

Using a sample of 3062 cases taken from the records of the Worker’s Compensation Fund of Utah.

Summary of results:

Safety: The risk of serious side effects of manipulation are sometimes inaccurately considered much greater than the scientific literature reports. This can be a contentious issue amongst health professionals. Very rare events such as stroke caused by release of an embolus from a pre-existing clot or a blood vessel wall dissection can potentially occur with morbid consequences. Haldeman reports approximately 1 in 5.8 million neck adjustments results in a serious adverse vascular event. (Haldeman et al. Spine vol24-8, 1999).

The risk of minor, short term side effects associated with physical therapy include soft tissue bruising and inflammation, muscle and ligament soreness, bone fracture, disc injury and temporary exacerbation of the underlying condition. 

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