Quality of Life

Outcome studies measuring health related quality of life (HRQL) are becoming increasingly sought as measures as to the value of a health intervention. In outcomes studies the overall wellness or well-being of a person is explored to ask the question, “Is this intervention truly benefiting the overall health of the patient or are we just treating symptoms or having a minimal effect on this patient’s life?” That is very important because doctors can give a patient a drug to lower their high blood pressure, but the result may be impotence. Doctors may give a drug to lower high cholesterol and the result may be suicide. Doctors may give a ability to relate to their environment rather than the diagnosis and treatment of symptoms and diseases. tk.

1) A longitudinal assessment of chiropractic care using a survey of self-rated health wellness & quality of life: a preliminary study. Marino MJ and Phillippa ML. Journal of Vertebral Subluxation Research 3(2), 1999.

• From the abstract: This longitudinal study evaluated changes in self-rated health status of patient receiving chiropractic care at the training clinic of the New Zealand School of Chiropractic. The study was designed to assess subluxation-based chiropractic care in association with changes in patients’ perceived health status. The Self-Rated Health/Wellness Survey (SRHW) was used to evaluate the health status on two occasions, “initial” and “follow-up.” The instrument assessed health across four domains, Physical State, Emotional/Mental State, Stress and Life Enjoyment. Collectively, these four domains, assessed initially and after a follow-up period, constituted Combined Wellness, or a fifth domain. Quality of Life was evaluated as a sixth domain of the questionnaire instrument. The study population included 89 subjects, evaluated over a five-month study period. The average interval between initial and follow-up surveys was 8.0+/- 3.2 weeks, with an average number of visits of 9.1 +/- 4.2. A bivariate analysis was conducted using a two tailed, paired, sample t-test to assess the subjects’ survey responses. Subjects reported significant positive perceived changes in Physical State (p=0.000) Mental/Emotional State (p=0.008), and Combined Wellness (p=0.001), with corresponding effect sizes of 0.61, 0.24 and 0.31 respectively. The improvement in the Physical and Mental/Emotional State, and Combined Wellness suggests that chiropractic care provided through the NZ School of Chiropractic is associated with significant benefits in these domains. Study data suggested that health/ wellness may accrue with time under care. Thus, further study with a larger sample size and longer duration of care is proposed to more thoroughly investigate possible health benefits in the areas studied, as well as to confirm present findings.

2) A retrospective assessment of network care using a survey of self-rated health, wellness and quality of life. Blanks, RHI, Schuster, TL. JVSR Vol. 1 No. 4, 1997.

• From the abstract: The present study represents a retrospective characterization of Network Care, a health care discipline within the subluxation-based chiropractic model. Data were obtained from 156 Network offices (49% practitioners participation rate) in the United States, Canada, Australia and Puerto Rico. This was a survey of 2818 patients of 156 Network chiropractic offices. Results indicated that patients reported significant positive perceived change in all four domains of health, as well as overall quality of life. The evidence of improved health in the four domains (physical state, mental/emotional state, stress evaluation, life enjoyment), overall quality of life from a standardized index and the “wellness coefficient,” suggests that Network Care is associated with significant benefits. These benefits are evident from as early as 1-3 months under care, and appear to show continuing clinical improvements in the duration of care …with no indication of a maximum clinical benefit.156
• Comment (tk): Network chiropractic is a combination of chiropractic techniques tailored to the specific needs of the patient. It capitalizes on the best that many traditional chiropractic techniques has to offer. This study is unique in its size, scale and scientific rigor.

3) Changes in general health status during upper cervical chiropractic care: PBR report. Owens, Edward F., Hoiriis, Kathryn T., Burd, Deana. Chiropractic Research Journal, Vol. V, No. 1, Spring 1998.

• This is a practice-based research project PBR: doctors in their private offices collected and pooled data on their patients.
• From the abstract: Data have been [so far] collected on 153 patients. Among the factors tested for are:
• physical functioning (PF) limitations in physical activities due to physical problems
• bodily pain (BP)
• general health (GH)
• vitality (V)
• social functioning (SF) – limitations in social activities due to physical or emotional problems
• mental health (MH)
• The preliminary results show that patients enter into upper cervical chiropractic care with a variety of mostly musculoskeletal complaints. At the outset of care, those patients have significantly lower health status, as measured by SF-36, than the general population. There is a general trend for patients to experience an upward trend in their perception of health as measured by both the SF-36 and the GWBS (global well-being score). Analysis of SF-36 scores showed improvement in all categories compared to the initial scores upon initial care. The average patient improvement was 12.1% within the first four weeks, and increased to 45.6% by maximum improvement. Overall, the chiropractic pa-tients on whom they had complete data improved on all subscales and show scores exceeding the national norms on four of the eight scales (GH, V, SF, MH). In addition, analysis of x-ray listing factors suggests that upper cervical chiropractic adjustment improves misalignment of the occipito-atlanto-axial spine. Although these results are encouraging many of our original questions go answered because of a lack of follow-up data. In addition, the sample size is too small; additional upper cervical chiropractic offices are needed as collection sites. Better tracking of patient attrition is required to assess the length of chiropractic care needed to reach maximum improvement for specific conditions.

4) Italian Study In 1987, a study of 17,142 patients (22 clinics) in Italy by medical physicians and chiropractors concluded:

• The results of our survey presented herein, are clear and incontrovertible: our sample population of over seventeen thousand patients treated with chiropractic for at least two years showed that this treatment could lead to a 75-55% reduction in the number of daily absences from work and could cut down the number of hospitalized patients by 87.60% vis-à-vis other currently used forms of treatment (pharmacological, psysiokinesitherapic, surgical, etc.)
• “A most meaningful indicator of the effectiveness of chiropractic is the improvement it produces in the quality of life, not only because of its curative effect but also thanks to its preventative and rehabilitative functions.” Chiropractic-Therapeutical effectiveness-Social importance. Incidence of Absence from work and Hospitalization. Survey on a Sample of 17,142 patients, Italy, 1987, Professor F. Splendori

5) British Medical Journal Publishes Follow-up to Meade Study. Mead TW, British Medical Journal August 5, 1995

• Chiropractic patients not only reported less pain than hospital patients at six weeks, but three years later chiropractic patients reported a 29% greater improvement with chiropractic compared to hospital treatment. The most dramatic improvements were associated with pain reduction, but many of the factors that contribute to the quality of life were affected by chiropractic care.
• Sitting for more than a short period of time and sleeping showed the most significant improvement, but scores such as personal care, lifting, walking, standing, sex life, social life, and ability to travel also improved.

6) Changes in salivary pH and General Health Status following the clinical application of bio-energetic synchronization. Morter T, Schuster T. JVSR 2(2), Jan. 1998.

• From the abstract: The present preliminary study investigated the relationship between autonomic nervous system imbalance, fasting salivary pH, and general health status following the clinical application of Bio-energetic Synchronization (BEST)….Twenty-four patients attending a four day program were separated into two groups of 12 each. Following the administration of BEST pH values increased significantly in the (subject) S-Group, and decreased significantly in the (placebo) P-group. Moreover, the G-group ex-pressed lower total scores (lowered perceived health status) than the P-Group… Based on these preliminary findings it is suggested that measurement of fasting salivary pH may be a reliable non-invasive means of substantiating pre/post intervention changes in autonomic imbalance…both groups (report) self-reported overall improvement in general health status concomitant with pH changes following the application of BEST. The preliminary findings support clinical observations suggesting that this approach is associated with restoration of autonomic balance. The relevance of this process to the etiology and correction of vertebral subluxation is discussed.

7) A study regarding measures of gerneral health status in patients using the Bio Energetic Synchronization Technique: a follow-up study. Blanks R and Dobson M. Journal of Vertebral Subluxation Research 3(2), 1999.

• From the Abstract: The present study was conducted to investigate the health benefits of Bio Energetic Synchronization Technique (BEST) in a large patient sample. Participants were attendees at one of ten consecutive, four day, in-residence health programs (Health Weeks) held between July, 1997 and July, 1998. The Health Week program consisted of a comprehensive four day program of intensive BEST care which has been linked to restoring autonomic nervous system balance, as well as reduction of subluxation. The technique also includes lifestyle and nutritional education. Patients were assessed with the Rand-36 health survey and the Global Well-Being Scale (GWBS) just prior to Health Week, and then eight weeks following the program. Following a structured clinical interview, assessment forms were administered by staff at the beginning or end of the four day event. The eight-week follow-up questionnaires were mailed to all study participants. Results indicate significant (p<0.006) improvement in six of the eight subscales of the Rand-36 health survey among the 205 participants completing both the pre and post Health Week assessment in the Rand-36 scores through the eight week follow-up. The GWBS was higher than the pre Health Week but lower than the post Health Week. These follow-up data demonstrate long term benefits derived during the Health Week program, and confirm a previous pilot study involving Health Week attendees. Further investigation relative to sociodemographic factors, which may influence the health and wellness outcomes associated with this form of care will be evaluated in future studies.

8) Chronic pediatric asthma and chiropractic spinal manipulation: A prospective clinical series and randomized clinical pilot study. Bronfort G, Evans RL, Kubic P, Filkin P. y. J Manipulative Physiol Ther 2001;24(6):369-77.

• The analysis tracked 36 youngsters with chronic mild or moderate asthma. All subjects were aged 6 to 17 years. Over a 3-month period, patients
  received either chiropractic adjustments or "sham" adjustments. In addition, all study participants underwent medical treatment.
• No difference was seen between chiropractic patients and controls in lung function or hyper-responsiveness. However,
  youngsters receiving chiropractic care "rated their quality of life substantially higher and their asthma severity substantially lower. These improvements were maintained at the 1-year follow-up assessment."