Chiropractic: General Efficacy, Safety, and Satisfaction  

Patient satisfaction with chiropractic physicians in an independent physicians' association. Gemmell HA, Hayes BM. J Manipulative Physiol Ther 2001; 24(9): 556-9

• Investigators distributed a survey to 150 patients who filed health insurance claims for chiropractic care during January and February, 2000.
  Results showed that “Various aspects of chiropractic care were given a rating of ‘excellent’ by the following percentage of respondents: Length of time to get an appointment (84.9%); convenience of the office (57.7%); access to the office by telephone (77.3%); length of wait at the office (75.7%); time spent with the provider (74.3%); explanation of what was done during the visit (72.8%); technical skills of the chiropractor (83.3%); and the personal manner of the chiropractor (92.4%). The visit overall was rated as excellent by 83.3% of responders, and 95.5% stated they would definitely recommend the provider to others.”
   

Risk assessment of neurological and/or vertebrobasilar complications in the pediatric chiropractic patient. (Risk of complications in pediatric patients under chiropractic care).

• Pistolese Richard A. Journal of Vertebral Subluxation Research, 2(2), June 1998 p. 73-81. How safe is chiropractic care for children? In this unique paper Richard Pistolese, research assistant for the International Chiropractic Pediatric Association (800-670-5437) computed both the number of chiropractic adjustments children have had and the risks of neurological/vertebrobasilar complications or injury. He found that in the period 1966 to 1977 over half a billion adjustments were delivered to children with an injury rate of one in 250 million.
• From the abstract: “This paper has reviewed literature concerning the occurrence of neurological and/or vertebrobasilar (N/VB) complications in patients receiving either specific chiropractic adjustments and/or non-specific manipulations of the spine."
• This topic was chosen due to the potentially severe consequences of N/VB complications, regardless of etiology….The number of pediatric visits, extrapolated to also include the periods between 1966 and 1977, was estimated to be 502,184,156….The estimate risk due to the pediatric chiropractic patient in this category of (N/VB) complication was estimated to be 4.0 x 10- 7% of all visits. Stated otherwise, there would be a chance of approximately 1 in 250 million pediatric visits that a N/VB complication would result.”
• Comment: A 1 in 250 million chance of injury means the patient has a greater chance of being hit by lightning than having an injury from a chiropractic adjustment. In discussion with the author, it was stated that the above statistics may actually be low and the chance of injury even less than 1 in 250 million. I know of no healing art with such a safe healing record.

Arterial dissections following cervical manipulation: the chiropractic experience. Haldeman S, Carey P, Townsend M, Papadopoulos C. CMAJ 2001; 165(7):905-6.

• A study in the Canadian Medical Association Journal finds that the risk of stroke from chiropractic cervical adjustments is extremely rare — and less likely than the risk of dying from the adverse effects of several painkillers.
• The research team led by Dr. Scott Haldeman examined all malpractice claims filed with the Canadian Chiropractic Protective Association (CCPA) between 1988 and 1997 to determine the number of stroke-related claims. In addition, a survey of 10% of practicing chiropractors in Canada asked doctors how many cervical manipulations they performed each year.
• Researchers calculated that there is a 1 in 5.85 million risk of stroke from cervical manipulation. This figure is far lower than the risk of being struck by lightening. It is also lower than the risk of dying from several common diagnostic tests and painkillers, indicating that chiropractic is an extraordinarily safe care option.

Patient satisfaction with chiropractic physicians in an independent physicians' association. Gemmell HA, Hayes BM. J Manipulative Physiol Ther 2001; 24(9): 556-9

• Investigators distributed a survey to 150 patients who filed health insurance claims for chiropractic care during January and February, 2000.
  Results showed that “Various aspects of chiropractic care were given a rating of ‘excellent’ by the following percentage of respondents:
• Length of time to get an appointment (84.9%)
• Convenience of the office (57.7%)
• Access to the office by telephone (77.3%)
• Length of wait at the office (75.7%); time spent with the provider (74.3%)
• Explanation of what was done during the visit (72.8%)
• Technical skills of the chiropractor (83.3%)
• The personal manner of the chiropractor (92.4%).
• The visit overall was rated as excellent by 83.3% of responders, and 95.5% stated they would definitely recommend the provider to others.”

Normal medical practice of referring patients for complementary therapies among Australian general practitioners. Easthope G, Tranter B, Gill G. Complement Ther Med. 2000;8(4):226-33.

• General medical practitioners (GPs) in Australia are referring more patients to chiropractors than ever before, researchers report. After reviewing two surveys of GPs in Tasmania and Victoria in 1997, investigators found that 55% of GPs in Tasmania and 93% of GPs in Victoria referred patients to chiropractors, osteopaths or massage therapists. The researchers concluded that chiropractic is part of the “normal health-care system” in Australia.

Complementary medicine and general practice: an urban perspective. Perry R, Dowrick CF. Complement Ther Med. 2000; 8(2):71-5.

• Medical physicians consider chiropractic tops in effectiveness among complementary approaches, according to a study conducted by researchers at the University of Liverpool in the Britain. As part of the analysis, investigators mailed surveys to all of the general practitioners in Liverpool. A total of 252 doctors responded. During the week prior to completing the survey, 13% had treated their patients directly with alternative therapies, 31% had referred patients to alternative practitioners and 38% had endorsed one or more complementary therapy. A total of 62% of doctors reported successful outcomes from alternative approaches. In contrast, 21% noted adverse reactions. Chiropractic and osteopathy were considered the most effective types of complementary therapy, while acupuncture was the most widely used.

Long-term trends in the use of complementary and alternative medical therapies in the United States Kessler RC, Davis RB, Foster DF, Van Rompay MI, Walters EE, Wilkey SA, Kaptchuk TJ, Eisenberg DM. . Ann Intern Med 2001;135(4):262-8.

• Harvard researchers have found that the use of complimentary and alternative medicine (CAM) is skyrocketing. Investigators conducted 2,055 telephone interviews of U.S. residents, aged 18 years or older. In total, 67.6% of respondents had tried at least one CAM therapy, such as chiropractic, acupuncture, yoga, biofeedback, nutritional supplementation or other approaches. Younger individuals were more likely to use CAM, compared with older people. Specifically, by age 33, 30% of pre-baby boomers, 50% of baby boomers and 70% of post-baby boomers had used CAM - regardless of socio-demographic makeup. "The findings really dispel two ideas, namely that complementary and alternative medicine is just a passing fad, and that it is used by one particular segment of society," said chief investigator, Ronald Kessler.

Spinal reflex attenuation associated with spinal manipulation. Dishman JD, Bulbulian R. Spine. 2000;25 (19):2519-25.

• Researchers from New York Chiropractic College in Seneca Falls, New York have documented that chiropractic adjustments and spinal mobilization produce short-term inhibition of the human motor system.
• To measure alpha motoneuron activity, researchers tested the tibial nerve Hoffmann reflex from the gastrocnemius muscle in 17 pain-free volunteers before and after spinal manipulation with thrust and mobilization without thrust. Both procedures inhibited alpha motoneuron activity immediately following intervention. Alpha motoneuron activity returned to pre-test levels within 30 seconds.
• The study’s authors concluded that their findings “substantiate the theory that manual spinal therapy procedures may lead to short-term inhibitory effects on the human motor system.” These findings may explain why spinal manipulation reduces electromyographic activity in low-back pain sufferers, explain researchers.

Training Primary Care Physicians to Give Limited Manual Therapy For Low Back Pain: Patient Outcomes. Curtis P, Carey TS, Evans P, Rowane MP, Mills Garrett J, Jackman A. Spine. 2000;25(22):2954-2961.

• In recent years, a growing number of primary care physicians have been practicing manual therapy techniques, including spinal manipulation. According to the results of this study, patients treated by these doctors experience only a “very modest benefit.”
• Investigators looked at the effectiveness of manual therapy performed by 31 generalists physicians (who completed a limited manual therapy training course) on 295 patients with back pain.
• Findings showed that no differences were found between patients treated with manual therapy and controls in Roland­ Morris scores over time, mean functional days to recovery, days absent from work, or patient satisfaction. However, patients who received manual therapy did recover faster — especially those who underwent more intensive treatments.

Adjustments affect nervous system more than massage. Electroencephalogr Clin Neurophysiol 2001; 41:97-106.

• A cohort of pain-free subjects received either chiropractic adjustments, massage or no treatment (control). Investigators used post-interventional H-reflex recordings to compare the motoneuron inhibition generated by spinal manipulation with the motoneuron inhibition generated by massage therapy.
• Findings revealed that "spinal manipulation significantly attenuated alpha motoneuronal activity immediately post-therapy, as measured by the amplitude of the tibial nerve H-reflex. Massage subjects exhibited no significant reduction in motoneuronal activity immediately following administration. Spinal manipulation produced a transient attenuation of alpha motoneuronal excitability. Paraspinal and limb massage did not inhibit the motoneuron pool as measured immediately post-therapy."
• "These findings support the supposition that spinal manipulation procedures lead to short-term inhibitory effects on motoneuron excitability to a greater magnitude than massage," conclude the study's authors.

Prevalence of nonmusculoskeletal complaints in chiropractic practice: Report from a practice-based research program.Hawk C, Long CR, Boulanger KT. J Manipulative Physiol Ther 2001;24(3):157-69

• Rresearchers evaluated data from 110 chiropractic offices in 32 states and 2 Canadian provinces. In total, 7,651 patients visited these offices during a designated week.
• Findings showed that "non-musculoskeletal complaints accounted for 10.3% of the chief complaints." Factors that boosted a patient’s likelihood of seeking care for non-musculoskeletal reasons were: being below 15 years of age; being female; presenting in a small town or rural location; having multiple complaints; having received medical care for the chief complaint; and having first received chiropractic care before 1960.
• Practices that provided care for the highest proportion of non-musculoskeletal cases tending to be in metropolitan areas and tended to offer more adjunctive therapies (such as nutritional recommendations, naturopathy and homeopathy), compared with practices that saw more musculoskeletal cases. In addition, an inverse correlation was evident between accepting health insurance and caring for non-musculoskeletal chief complaints.

Effects of side-posture positioning and side-posture adjusting on the lumbar zygapophysial joints as evaluated by magnetic resonance imaging: a before and after study with randomization. Cramer GD, Tuck NR Jr, Knudsen JT, Fonda SD, Schliesser JS, Fournier JT, Patel P. J Manipulative Physiol Ther. 2000; 23(6):380-94.

• Chiropractic adjustments increase the separation (gapping) in zygapophysial joints. A cohort of 8 female and 8 male students, aged 22 to 29 years, were enrolled in the study. The subjects underwent magnetic resonance imaging (MRI) before and after either receiving lumbar side-posture adjustment or resting in side-posture position. Measurements were taken comparing the anterior to posterior space of the z joints before and after the intervention. Three radiologists also analyzed the images. Findings revealed that adjustments produced a greater gapping of the z joints than did side-posture positioning alone.